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

Distinctive Dermatology PLLC

Organization Dermatology Physician · NPI 1962088138

Distinctive Dermatology PLLC is a Dermatology Physician in Lake Wales, Florida. Works from 2 locations. Registered with an NPI since 2021.

In the registry since
2021
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

134 E Tillman Ave
Lake Wales, FL 33853-4130
Phone: (863) 269-0790
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1255 State Road 60 E Ste 100, Lake Wales, FL 33853-4310 — (863) 269-0790

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X

Record details

NPI number1962088138
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Raymond Knisley — Owner · (863) 269-0790
Other names Lake Wales Dermatology
NPI enumeratedMarch 19, 2021
Last updated in NPPESApril 14, 2021
Certification dateApril 14, 2021
Mailing address134 E Tillman Ave, Lake Wales, FL 33853-4130

Other providers in Lake Wales