Bold City Dermatology LLC in St Augustine, FL
This organization bills under NPI 1538761655, an organization record issued on Nov 13, 2020 with the primary taxonomy MOHS-Micrographic Surgery Physician. Each clinician who works there has their own NPI and license.
Organization recordNPPES, Aug 2026
1538761655
- Legal name
- Bold City Dermatology LLC
- Entity
- Type 2 · organization
- Primary taxonomy
- MOHS-Micrographic Surgery Physician 207ND0101X
- Practice location
- 316 PASEO REYES DR, St Augustine, FL 32095
- Phone
- 904-544-5800
- Enumerated
- Nov 13, 2020
- Record updated
- Jan 26, 2021
- Authorized official
- Owner (title as filed)
5 clinicians CMS lists with Bold City Dermatology in St Augustine
- Bishr Al Dabagh, MDMOHS-Micrographic Surgery Physician1154565661
- Kelly Auclair, APRNFamily Nurse Practitioner1013898758
- Loren Bonenclark, PA-CPhysician Assistant1639629579
- Nicole Cavignaro, PA-CPhysician Assistant1508527748
- Sarah Ferrer-Bruker, DODermatology Physician1750619474
Source: CMS Doctors and Clinicians group affiliations, matched by practice name and city.
Checking an organization
- Confirm the business with the Florida secretary of state (Sunbiz).
- Check the HHS-OIG exclusion list for the organization.
- Verify each clinician on their own record and the state license search.
All taxonomies on this record
- 207N00000X Dermatology Physician
- 207ND0101X MOHS-Micrographic Surgery Physician
- 207NP0225X Pediatric Dermatology Physician
- 207NS0135X Procedural Dermatology Physician
Common questions
Is an organization NPI a license?
No. An NPI identifies who bills. Facilities and the clinicians who work there are licensed separately by the state.
Source: CMS National Plan and Provider Enumeration System (NPPES), monthly file of Aug 9, 2026 (NPPES files on CMS.gov). An NPI identifies who bills; it is not a license.