Healthcare Provider Details

I. General information

NPI: 1154395390
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 WEST MAIN STREET
BRONSON FL
32621-6338
US

IV. Provider business mailing address

66 WEST MAIN STREET
BRONSON FL
32621-6338
US

V. Phone/Fax

Practice location:
  • Phone: 352-486-5300
  • Fax: 352-486-5306
Mailing address:
  • Phone: 352-486-5300
  • Fax: 352-486-5306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. BARBARA L LOCKE
Title or Position: ADMINISTRATOR
Credential: MPH RN
Phone: 352-486-5300