Active NPI 1154318137 Individual Practitioner Female Practitioner

Meg Pierce , PA

Physician Assistant • Ormond Beach, FL

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Meg Pierce, PA is a certified Physician Assistant practicing in Ormond Beach, FL. With approximately 27 years of clinical experience since completing medical education in 1999, Meg Pierce delivers high-quality medical care to the local community at 400 LAKEBRIDGE PLAZA DR.

Meg Pierce is affiliated with Parks Dermatology Center Llc and accepts Medicare assignment.

Frequently performed procedures and clinical services include destruction of precancer skin growth, 2-14 growths, biopsy of related skin growth, tangential biopsy of single skin lesion. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

400 Lakebridge Plaza Dr

Ormond Beach, FL 321745157

Telephone 3866779044

Fax 3866773083

Associated Practice Facility / Clinic

🏢 Parks Dermatology Center Llc Facility NPI 1629063680

Medicare Profile & Education

Medical School

Other

Graduation Year

1999

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Ormond Beach, FL

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

27 Yrs +13.0 yrs vs City Avg

City Avg: 14.0 Yrs

State Avg: 11.1 Yrs

Regional Practice Density

33 Specialists

Practicing in Ormond Beach, FL (10376 Statewide)

Telehealth Adoption Rate

18.2% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

44.1% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Pierce (27 Years) 27 Yrs

Ormond Beach Specialty Average (14.0 Years) 14.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,563	437	$9.03	$5.31
11103 Biopsy of related skin growth, each additional growth	1,345	477	$69.38	$40.75
11102 Tangential biopsy of single skin lesion	1,021	768	$139.59	$72.94
99213 Established patient office or other outpatient visit, typically 15 minutes	975	700	$125.64	$75.22
17000 Destruction of skin growth	714	562	$92.83	$35.69
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	686	518	$177.87	$106.25
17110 Destruction of up to 14 skin growths	352	306	$155.76	$90.45
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	207	143	$248.04	$120.81
17004 Destruction of precancer skin growth, 15 or more growths	194	161	$234.12	$136.42
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	99	87	$78.37	$46.68
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	89	43	$648.65	$388.51
69100 Biopsy of ear	56	46	$134.06	$45.20
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	55	55	$157.18	$92.99
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	33	30	$262.19	$145.68
96573 Application of light by qualified health care professional to destroy precancer skin growth	32	32	$309.55	$178.78
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	25	25	$233.28	$139.62
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	19	17	$238.84	$133.35
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	19	17	$268.06	$150.44
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	18	14	$286.44	$154.80
17111 Destruction of skin growth, 15 or more growths	17	14	$182.67	$108.37
Q0112 All potassium hydroxide (koh) preparations	14	11	$20.00	$5.71
10060 Simple or single drainage of skin abscess	11	11	$174.06	$99.74

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,383	366	$9.01	$5.48
11103 Biopsy of related skin growth, each additional growth	1,623	501	$69.27	$42.11
11102 Tangential biopsy of single skin lesion	1,045	754	$139.35	$73.93
99213 Established patient office or other outpatient visit, typically 15 minutes	955	695	$125.43	$76.24
17000 Destruction of skin growth	592	476	$92.66	$34.11
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	545	441	$177.60	$107.93
17110 Destruction of up to 14 skin growths	383	333	$155.47	$91.68
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	322	181	$247.45	$115.60
17004 Destruction of precancer skin growth, 15 or more growths	214	173	$233.75	$142.07
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	108	99	$78.26	$47.55
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	79	41	$546.72	$384.76
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	73	60	$261.40	$138.40
69100 Biopsy of ear	43	38	$133.53	$49.19
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	40	40	$156.99	$95.38
96573 Application of light by qualified health care professional to destroy precancer skin growth	40	39	$309.17	$187.84
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	29	25	$266.93	$145.83
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	25	23	$238.37	$127.55
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	25	20	$203.84	$86.83
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	19	19	$232.98	$141.56
17111 Destruction of skin growth, 15 or more growths	15	15	$182.08	$110.86
17271 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	11	11	$230.44	$102.16

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,180	375	$9.21	$5.60
11103 Biopsy of related skin growth, each additional growth	1,546	485	$71.23	$43.22
11102 Tangential biopsy of single skin lesion	908	715	$142.39	$77.38
99213 Established patient office or other outpatient visit, typically 15 minutes	671	532	$127.26	$77.19
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	632	516	$179.16	$108.85
17000 Destruction of skin growth	609	498	$94.01	$34.85
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	298	181	$249.96	$117.09
17110 Destruction of up to 14 skin growths	281	248	$157.30	$92.50
17004 Destruction of precancer skin growth, 15 or more growths	190	157	$234.40	$142.06
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	102	96	$79.27	$48.17
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	78	39	$543.79	$388.57
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	62	46	$264.71	$133.48
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	58	58	$158.48	$96.46
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	55	55	$236.36	$143.69
69100 Biopsy of ear	53	47	$135.58	$48.18
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	29	24	$288.27	$153.76
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	26	23	$270.68	$142.36
96573 Application of light by qualified health care professional to destroy precancer skin growth	22	22	$318.99	$193.10
Q0112 All potassium hydroxide (koh) preparations	21	20	$20.48	$5.77
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	19	16	$205.19	$91.75
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	19	17	$195.41	$119.15
99202 New patient office or other outpatient visit, typically 20 minutes	15	15	$102.27	$62.34
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	12	12	$252.04	$127.64
11104 Punch biopsy, first skin growth	12	12	$177.03	$107.55
10060 Simple or single drainage of skin abscess	11	11	$174.36	$105.83

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,658	292	$8.62	$5.42
11103 Biopsy of related skin growth, each additional growth	1,041	373	$68.83	$44.96
11102 Tangential biopsy of single skin lesion	810	651	$136.11	$77.71
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	685	540	$170.45	$111.44
99213 Established patient office or other outpatient visit, typically 15 minutes	555	458	$120.32	$78.43
17000 Destruction of skin growth	496	428	$87.05	$35.02
17110 Destruction of up to 14 skin growths	321	293	$148.42	$92.64
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	314	188	$231.76	$124.55
17004 Destruction of precancer skin growth, 15 or more growths	159	128	$215.32	$141.06
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	116	103	$74.39	$47.87
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	69	69	$147.36	$96.88
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	48	48	$221.30	$145.29
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	48	12	$5.53	$1.27
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	42	21	$543.79	$386.69
69100 Biopsy of ear	40	37	$128.31	$49.82
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	40	33	$253.09	$157.05
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	33	26	$247.67	$139.53
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	22	14	$195.32	$77.72
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	22	22	$187.08	$119.71
Q0112 All potassium hydroxide (koh) preparations	21	14	$29.05	$5.83
11104 Punch biopsy, first skin growth	19	19	$169.71	$110.47
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	15	12	$224.87	$114.03
99202 New patient office or other outpatient visit, typically 20 minutes	14	14	$95.65	$62.66
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	11	11	$18.35	$12.01
17111 Destruction of skin growth, 15 or more growths	11	11	$173.74	$112.92

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,877	314	$8.23	$5.04
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	822	715	$152.84	$93.58
11103 Biopsy of related skin growth, each additional growth	815	330	$74.35	$45.61
11102 Tangential biopsy of single skin lesion	757	620	$139.51	$77.09
17000 Destruction of skin growth	491	419	$91.45	$35.61
99213 Established patient office or other outpatient visit, typically 15 minutes	453	351	$105.30	$64.44
17110 Destruction of up to 14 skin growths	280	249	$155.25	$91.76
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	279	188	$247.31	$129.79
17004 Destruction of precancer skin growth, 15 or more growths	159	131	$220.53	$134.82
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	80	80	$151.66	$92.83
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	60	29	$547.37	$389.72
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	57	53	$63.63	$38.95
69100 Biopsy of ear	40	36	$137.61	$51.63
99202 New patient office or other outpatient visit, typically 20 minutes	37	37	$106.80	$65.29
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	30	29	$225.00	$109.97
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	27	24	$263.34	$145.46
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	24	24	$269.61	$165.02
Q0112 All potassium hydroxide (koh) preparations	20	15	$27.50	$5.78
11104 Punch biopsy, first skin growth	16	14	$174.94	$107.34
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	13	12	$239.13	$123.96
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	11	11	$203.64	$78.94

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,270	382	$8.00	$4.84
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,064	876	$150.00	$92.57
11102 Tangential biopsy of single skin lesion	752	613	$138.00	$73.85
17000 Destruction of skin growth	607	509	$92.00	$37.59
11103 Biopsy of related skin growth, each additional growth	515	258	$75.00	$45.16
99213 Established patient office or other outpatient visit, typically 15 minutes	443	341	$101.00	$63.18
17110 Destruction of up to 14 skin growths	402	357	$153.21	$90.77
17004 Destruction of precancer skin growth, 15 or more growths	249	201	$209.00	$129.92
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	187	128	$244.00	$128.94
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	91	91	$152.00	$92.68
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	62	33	$404.59	$391.71
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	56	52	$61.00	$38.21
99202 New patient office or other outpatient visit, typically 20 minutes	44	44	$104.00	$64.99
69100 Biopsy of ear	36	35	$140.00	$72.17
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	33	32	$225.00	$102.07
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	29	26	$266.00	$162.41
17111 Destruction of skin growth, 15 or more growths	28	26	$182.00	$111.12
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	27	27	$260.00	$149.22
Q0112 All potassium hydroxide (koh) preparations	23	20	$30.00	$5.71
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	14	12	$200.00	$101.56
40490 Biopsy of lip	11	11	$182.00	$108.46

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,536	395	$8.00	$4.49
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,098	887	$150.00	$90.71
11100 Biopsy of single growth of skin and/or tissue	786	631	$145.00	$77.86
17000 Destruction of skin growth	616	508	$92.00	$37.77
11101 Biopsy of each additional growth of skin and/or tissue	555	270	$55.00	$27.98
99213 Established patient office or other outpatient visit, typically 15 minutes	510	394	$101.00	$61.44
17110 Destruction of up to 14 skin growths	422	370	$153.09	$91.49
17004 Destruction of precancer skin growth, 15 or more growths	302	240	$209.00	$122.23
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	238	164	$244.00	$123.36
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	120	111	$61.00	$36.83
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	89	89	$152.00	$91.58
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	64	33	$373.56	$367.63
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	45	42	$260.00	$144.42
17111 Destruction of skin growth, 15 or more growths	42	36	$182.00	$108.29
69100 Biopsy of ear	33	32	$140.00	$61.70
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	33	32	$225.00	$93.17
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	32	31	$266.16	$159.66
99202 New patient office or other outpatient visit, typically 20 minutes	27	27	$104.00	$63.28
99201 New patient office or other outpatient visit, typically 10 minutes	17	17	$61.00	$37.60
10060 Simple or single drainage of skin abscess	16	15	$165.00	$100.43
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	14	13	$200.00	$100.03
Q0112 All potassium hydroxide (koh) preparations	13	13	$13.08	$5.71

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,248	362	$8.00	$4.76
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	925	790	$150.00	$90.25
11100 Biopsy of single growth of skin and/or tissue	719	583	$145.00	$78.45
17000 Destruction of skin growth	560	475	$92.00	$38.66
11101 Biopsy of each additional growth of skin and/or tissue	472	232	$55.00	$27.92
99213 Established patient office or other outpatient visit, typically 15 minutes	434	352	$101.11	$61.32
17110 Destruction of up to 14 skin growths	346	311	$153.00	$89.76
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	306	250	$61.00	$36.47
17004 Destruction of precancer skin growth, 15 or more growths	259	202	$209.00	$126.31
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	201	140	$244.00	$123.10
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	84	47	$347.62	$342.16
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	72	72	$152.00	$91.35
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	48	47	$225.00	$110.00
99201 New patient office or other outpatient visit, typically 10 minutes	47	47	$61.00	$36.93
69100 Biopsy of ear	45	37	$140.00	$56.29
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	33	28	$266.00	$148.83
17111 Destruction of skin growth, 15 or more growths	32	28	$182.00	$106.46
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	31	25	$260.00	$136.78
99202 New patient office or other outpatient visit, typically 20 minutes	24	24	$104.00	$62.90
10060 Simple or single drainage of skin abscess	15	13	$165.00	$95.58

Medical Specialties & State Licenses

CMS Verified: 2025-01-22

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License FL PA9101472

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Dermatology

NUCC Taxonomy Code: 207N00000X

State License FL PA9101472

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Hospital & Practice Group Affiliations

Parks Dermatology Center Llc

400 Lakebridge Plaza Dr, Ormond Beach, FL 321745157

Phone: 3866779044

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

13 Associated Practitioners

Dr. Michael Suah , MD

Dermatology

NPI 1114912466

Doctor of Medicine (M.D.)

Dr. Courtney Bernett , DO

Dermatology

NPI 1265887152

Doctor of Osteopathic Medicine (D.O.)

Margaret Hewitt

Physician Assistant

NPI 1295671865

Dr. Jeffrey Parks , MD

Dermatology

NPI 1336134360

Doctor of Medicine (M.D.)

Dr. John Coppola , DO

Dermatology

NPI 1346462181

Doctor of Osteopathic Medicine (D.O.)

Julianne Mitchell , APRN

Nurse Practitioner

NPI 1417775206

Advanced Practice Registered Nurse

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active September 14, 2016

NPI status registered as active in NPPES database

📍

Updated Practice Location September 14, 2016

Registered at 400 LAKEBRIDGE PLAZA DR, ORMOND BEACH, FL 321745157 (Tel: 3866779044)

📍

Updated Business Mailing Address September 14, 2016

Registered at 400 LAKEBRIDGE PLAZA DR, ORMOND BEACH, FL 321745157 (Tel: 3866779044)

👤

Provider Name / Credentials Updated September 14, 2016

Recorded as MEG PIERCE, PA

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) September 14, 2016

Dermatology (License #PA9101472 in FL)

🟢

Initial NPI Registration & Enumeration October 04, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1154318137

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: October 04, 2005

Last Update: January 22, 2025

Sole Proprietor: No

Update or Correct Profile

Mailing Address

400 Lakebridge Plaza Dr

Ormond Beach, FL 321745157

Phone: 3866779044

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.