Healthcare Provider Details

I. General information

NPI: 1851350409
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 CENTRAL AVE SE
JASPER FL
32052-6153
US

IV. Provider business mailing address

PO BOX 267
JASPER FL
32052-0267
US

V. Phone/Fax

Practice location:
  • Phone: 386-792-1414
  • Fax: 386-792-2352
Mailing address:
  • Phone: 386-792-1414
  • Fax: 386-792-2352

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: MRS. DIANA DUQUE
Title or Position: INTERIM ADMINISTRATOR
Credential:
Phone: 352-727-0542