LUMINARY DERMATOLOGY PA NPI 1851955983

NPI Information

  • NPI: 1851955983
  • Provider Name: LUMINARY DERMATOLOGY, PA
  • Classification: Dermatology - 207ND0101X
  • Specialization: MOHS-Micrographic Surgery
  • Entity Type: Organization
  • CLIA Number: 10D2251108
  • Address: 2101 61ST ST W
    BRADENTON, FL
    ZIP 34209
  • Phone: (941) 926-6553

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NPI Details

LUMINARY DERMATOLOGY, PA is a mohs-micrographic surgery dermatology in Bradenton, FL. The provider is the highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. LUMINARY DERMATOLOGY, PA NPI is 1851955983. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2101 61ST ST W
BRADENTON, FL
ZIP 34209-528
Phone: (941) 926-6553

The provider's authorized official is Jessica Lynn Phillips .
The authorized official title is Ceo and has the following contact phone number (941) 302-4669.

The CLIA number assigned to this NPI record is 10D2251108 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 4/24/2019 and was last updated on 1/27/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialistNo
2207N00000XDermatologyNo
3207ND0101XDermatologyMOHS-Micrographic SurgeryYes
4207VG0400XObstetrics & GynecologyGynecologyNo
5208200000XPlastic SurgeryNo
6208600000XSurgeryNo
7208D00000XGeneral PracticeNo
8363A00000XPhysician AssistantNo
9363L00000XNurse PractitionerNo
10363LA2200XNurse PractitionerAdult HealthNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1B8XVQOTHERFLORIDAFLORIDA BLUE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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