Healthcare Provider Details

I. General information

NPI: 1285600213
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 DR CARTER BLVD
BUNNELL FL
32110-6212
US

IV. Provider business mailing address

301 DR CARTER BLVD PO BOX 847
BUNNELL FL
32110-6212
US

V. Phone/Fax

Practice location:
  • Phone: 386-437-7350
  • Fax: 386-437-8207
Mailing address:
  • Phone: 386-437-7350
  • Fax: 386-437-8207

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: MR. PATRICK JOHNSON
Title or Position: ADMINISTRATOR
Credential: R.N
Phone: 386-437-7350