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

State Wide Dermatology LLC

Organization Dermatology Physician · NPI 1427473073

State Wide Dermatology LLC is a Dermatology Physician in Odessa, Florida. Registered with an NPI since 2014.

In the registry since
2014
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

17121 Rainbow Ter
Odessa, FL 33556-2107
Phone: (813) 749-6907
Fax: (813) 475-7831
Show map & directions

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

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X

Record details

NPI number1427473073
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kathleen Harrell — Owner · (813) 749-6907
NPI enumeratedFebruary 19, 2014
Last updated in NPPESJuly 28, 2014
Mailing address17121 Rainbow Ter, Odessa, FL 33556-2107