Healthcare Provider Details

I. General information

NPI: 1679548861
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16140 US HWY 441
EUSTIS FL
32726-1305
US

IV. Provider business mailing address

P.O. BOX 1305
TAVARES FL
32778-1305
US

V. Phone/Fax

Practice location:
  • Phone: 352-589-6424
  • Fax: 352-589-6492
Mailing address:
  • Phone: 352-589-6424
  • Fax: 352-589-6492

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: MR. AARON KISSLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 352-589-6424