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

Southside Dermatology, PA

Organization Specialist · NPI 1023276607

Southside Dermatology, PA is a Specialist in Jacksonville, Florida. Licensed in Florida. Registered with an NPI since 2008.

Licensed in
FL
In the registry since
2008
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4727 Sunbeam Rd Ste 101
Jacksonville, FL 32257-6107
Phone: (904) 880-0622
Fax: (904) 880-0623
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence ME16473 (FL)

Record details

NPI number1023276607
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mary Pentel — President · (904) 880-0622
NPI enumeratedMay 29, 2008
Last updated in NPPESJuly 2, 2014
Mailing address4727 Sunbeam Rd, Suite 101, Jacksonville, FL 32257-6107

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