INTRACOASTAL DERMATOLOGY, PLLC
NPI 1194079988
Dermatology in Jacksonville, FL

Active since November 01, 2012
4776 HODGES BLVD STE 105, JACKSONVILLE, FL 32224(904) 655-5310 Get Directions Write a Review

NPPES record last updated: January 24, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Intracoastal Dermatology, Pllc NPPES

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

INTRACOASTAL DERMATOLOGY, PLLC (NPI 1194079988) is a healthcare organization registered as a dermatology in Jacksonville, Florida and active in the NPI registry since November 2012. The organization lists Kendall Adkisson, Manager, as its authorized official.

NPPES Registry Identity

NPI1194079988
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameINTRACOASTAL DERMATOLOGY, PLLC
Location Address4776 HODGES BLVD STE 105Jacksonville, FL 32224-7218
Mailing Address4776 Hodges Blvd Ste 105Jacksonville, FL 32224-7218 · (904) 655-5310
Organization SubpartNo
Authorized OfficialKendall AdkissonManager · (904) 655-5310
Enumeration DateNovember 1, 2012
Last NPPES UpdateJanuary 24, 2022
NPPES CertifiedJanuary 24, 2022
NPI 1194079988 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License Licensed in FL · ME110325
Definition
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.
4776 HODGES BLVD STE 105, Jacksonville, FL 32224

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

Other Providers at the Same Location NPPES

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

Physician Assistant
4776 HODGES BLVD STE 105
JACKSONVILLE, FL 32224

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 Intracoastal Dermatology, PLLC's NPI number?

The NPI number for Intracoastal Dermatology, PLLC is 1194079988. It was assigned to this organization in the NPPES registry on November 1, 2012.

Where is Intracoastal Dermatology, PLLC located?

Intracoastal Dermatology, PLLC is located at 4776 Hodges Blvd Ste 105, Jacksonville, FL 32224. The listed phone number is (904) 655-5310.

What is Intracoastal Dermatology, PLLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

What insurance does Intracoastal Dermatology, PLLC accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Intracoastal Dermatology, PLLC 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 Intracoastal Dermatology, PLLC was last updated on January 24, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.