Healthcare Provider Details

I. General information

NPI: 1639148919
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SIMONTON ST
KEY WEST FL
33040-3110
US

IV. Provider business mailing address

1100 SIMONTON ST
KEY WEST FL
33040-3110
US

V. Phone/Fax

Practice location:
  • Phone: 305-293-7500
  • Fax: 305-292-6872
Mailing address:
  • Phone: 305-293-7500
  • Fax: 305-292-6872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT EADIE
Title or Position: ADMINSTRATOR
Credential: JD
Phone: 305-809-5610