Healthcare Provider Details

I. General information

NPI: 1548236623
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 WEST LOWDER STREET
MACCLENNY FL
32063
US

IV. Provider business mailing address

480 WEST LOWDER STREET
MACCLENNY FL
32063
US

V. Phone/Fax

Practice location:
  • Phone: 904-259-6291
  • Fax: 904-259-1950
Mailing address:
  • Phone: 904-259-6291
  • Fax: 904-259-1950

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. JOE PIETRANGELO
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-259-6291