MEDICARE: FLORIDA DEPARTMENT OF VETERANS AFFAIRS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		FL
2	311500000X	Alzheimer Center (Dementia Center)		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316939804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA DEPARTMENT OF VETERANS AFFAIRS

Provider Business Mailing Address
First Line	:	6919 PARKWAY BLVD
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-2909
Country	:	US
Telephone Number	:	813-558-5000
Fax Number	:	813-558-5021

Provider Business Practice Location Address
First Line	:	6919 PARKWAY BLVD
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-2909
Country	:	US
Telephone Number	:	727-518-3202
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MR. WILLIAM G PUCKETT
Credential	:
Telephone Number	:	727-518-3202

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	09/11/2025

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