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SOUTHSIDE DERMATOLOGY, P.A.
NPI 1023276607
Specialist in Jacksonville, FL

Active since May 29, 2008CLIA Certified · 2 labs
4727 SUNBEAM RD, SUITE 101, JACKSONVILLE, FL 32257(904) 880-0622(904) 880-0623 Get Directions Write a Review

NPPES record last updated: July 2, 2014. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Southside Dermatology, P.a. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHSIDE DERMATOLOGY, P.A. (NPI 1023276607) is a healthcare organization registered as a specialist in Jacksonville, Florida and active in the NPI registry since May 2008. The organization holds 2 active CLIA laboratory certificates and lists Mary Trinh Pentel, President, as its authorized official.

NPPES Registry Identity

NPI1023276607
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameSOUTHSIDE DERMATOLOGY, P.A.
Location Address4727 SUNBEAM RD, SUITE 101Jacksonville, FL 32257-6107
Mailing Address4727 Sunbeam Rd, Suite 101Jacksonville, FL 32257-6107 · (904) 880-0622 · Fax (904) 880-0623
Phone(904) 880-0622
Fax(904) 880-0623
Organization SubpartNo
Authorized OfficialMary Trinh PentelPresident · (904) 880-0622
Enumeration DateMay 29, 2008
Last NPPES UpdateJuly 2, 2014
✔ NPI 1023276607 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in FL · ME16473
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
4727 SUNBEAM RD, Jacksonville, FL 32257
Open in Google Maps ↗

Other Identifiers 1

Medicare PINK1890FL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include AvMed.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 10D1099045

Southside Dermatology PA · Jacksonville, FL
Active · expires Jun 15, 2027
CLIA Number10D1099045
Laboratory TypePhysician Office
Certificate Effective DateJune 16, 2025
Certificate Expiration DateJune 15, 2027
Laboratory DirectorDr. Mary T. Pentel
Laboratory Phone(904) 880-0622
Laboratory LocationSouthside Dermatology PA4727 Sunbeam Road Suite 102, Jacksonville, FL 32257
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Compliance 10D2262657

Southside Dermatology PA · Jacksonville Beach, FL
Active · expires Jan 25, 2027
CLIA Number10D2262657
Laboratory TypePhysician Office
Certificate Effective DateJanuary 26, 2025
Certificate Expiration DateJanuary 25, 2027
Laboratory DirectorMary T. Pentel
Laboratory Phone(904) 880-0622
Laboratory LocationSouthside Dermatology PA1807 3rd Street North, Jacksonville Beach, FL 32250
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. JENIFER SCOTT GEORGE MSN, APRN, FNP-BC
Registered Nurse (General Practice)
4727 SUNBEAM RD
JACKSONVILLE, FL 32257
Duval County (904) 880-0622
DR. MARY TRINH PENTEL M.D.
Dermatology
4727 SUNBEAM RD, SUITE 101
JACKSONVILLE, FL 32257
Duval County (904) 880-0622
MRS. CARMEN JOSEFA RAMIREZ-BOYD CRFNP
Nurse Practitioner
4727 SUNBEAM RD
JACKSONVILLE, FL 32257
Duval County (904) 880-0622
DR. JULIA CLARKSON ARNP
Nurse Practitioner (Family)
4727 SUNBEAM RD, #102
JACKSONVILLE, FL 32257
Duval County (904) 400-7772

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southside Dermatology, P.A.'s NPI number?

The NPI number for Southside Dermatology, P.A. is 1023276607. It was assigned to this organization in the NPPES registry on May 29, 2008.

Where is Southside Dermatology, P.A. located?

Southside Dermatology, P.A. is located at 4727 Sunbeam Rd Suite 101, Jacksonville, FL 32257. The listed phone number is (904) 880-0622.

What is Southside Dermatology, P.A.'s specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does Southside Dermatology, P.A. hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Southside Dermatology, P.A. accept?

Health plans from AvMed list Southside Dermatology, P.A. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Southside Dermatology, P.A. was last updated on July 2, 2014. NPI Profile syncs with the weekly NPPES data releases published by CMS.