MEDICARE: FLORIDA DEPARTMENT OF HEALTH

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	251K00000X	Public Health or Welfare Agency

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	99635	OTHER	FL	BCBSFL
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558334367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA DEPARTMENT OF HEALTH

Provider Business Mailing Address
First Line	:	PO BOX 429
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34106-0429
Country	:	US
Telephone Number	:	239-252-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3339 E TAMIAMI TRL STE 145
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34112-5361
Country	:	US
Telephone Number	:	239-252-8200
Fax Number	:	239-252-2569

Authorized Official
Title or Position	:	ASSISTANT CHD ADMINISTRATOR
Name	:	ALAN PORTIS
Credential	:
Telephone Number	:	239-252-8206

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	06/08/2023

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1518034008 — DR. GEORGE BRONSKY M.D.
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1609907898 — LOTY S. FALL ARNP
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Directions to “FLORIDA DEPARTMENT OF HEALTH ” Practice Location

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