Healthcare Provider Details

I. General information

NPI: 1164493664
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 W SOVEREIGN PATH
LECANTO FL
34461-8071
US

IV. Provider business mailing address

3700 W SOVEREIGN PATH
LECANTO FL
34461-8071
US

V. Phone/Fax

Practice location:
  • Phone: 352-527-0068
  • Fax: 352-527-8858
Mailing address:
  • Phone: 352-527-0068
  • Fax: 352-527-8858

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: MS. GOODMAN TERESA
Title or Position: ASSISTANT DIRECTOR
Credential: ARNP
Phone: 352-527-0068