Healthcare Provider Details

I. General information

NPI: 1891874707
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SUWANNEE AVE
BRANFORD FL
32008
US

IV. Provider business mailing address

PO BOX 268
BRANFORD FL
32008-0268
US

V. Phone/Fax

Practice location:
  • Phone: 386-935-1133
  • Fax: 386-935-1362
Mailing address:
  • Phone: 386-935-1133
  • Fax: 386-935-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: PAMELA BLACKMON
Title or Position: ADMINISTRATOR
Credential: RN, BSN, MPH
Phone: 386-362-2708