Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Boca Grande Dermatology PLLC

Organization Dermatology Physician · NPI 1063836773

Boca Grande Dermatology PLLC is a Dermatology Physician in Boca Grande, Florida. Licensed in Florida. Registered with an NPI since 2014.

Licensed in
FL
In the registry since
2014
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

320 Park Ave
Boca Grande, FL 33921
Phone: (941) 964-0490
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence ME116621 (FL)

Record details

NPI number1063836773
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Timothy Corey — Manager · (941) 855-9372
NPI enumeratedFebruary 17, 2014
Last updated in NPPESDecember 9, 2014
Mailing addressPo Box 1883, 415 Rock Dove Dr, Boca Grande, FL 33921-1883