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

Intracoastal Dermatology, PLLC

Organization Dermatology Physician · NPI 1194079988

Intracoastal Dermatology, PLLC is a Dermatology Physician in Jacksonville, Florida. Licensed in Florida. Registered with an NPI since 2012.

Licensed in
FL
In the registry since
2012
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4776 Hodges Blvd Ste 105
Jacksonville, FL 32224-7218
Phone: (904) 655-5310
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence ME110325 (FL)

Record details

NPI number1194079988
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kendall Adkisson — Manager · (904) 655-5310
NPI enumeratedNovember 1, 2012
Last updated in NPPESJanuary 24, 2022
Certification dateJanuary 24, 2022
Mailing address4776 Hodges Blvd Ste 105, Jacksonville, FL 32224-7218

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