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

Coral Reef Dermatology LLC

Organization Dermatology Physician · NPI 1487300521

Coral Reef Dermatology LLC is a Dermatology Physician in Port St Lucie, Florida. Registered with an NPI since 2022.

In the registry since
2022
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

160 NW Central Park Plz Ste 103
Port St Lucie, FL 34986
Phone: (772) 882-5612
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X

Record details

NPI number1487300521
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Charlene Moore — Owner/Manager · (772) 882-5612
NPI enumeratedFebruary 28, 2022
Last updated in NPPESFebruary 28, 2022
Certification dateFebruary 28, 2022
Mailing address160 Nw Central Park Plaza Suite 103, Port St Lucie, FL 34986

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