Healthcare Provider Details

I. General information

NPI: 1386611085
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SW VIRGINIA CIR
MAYO FL
32066-4064
US

IV. Provider business mailing address

PO BOX 6030
LIVE OAK FL
32064-6030
US

V. Phone/Fax

Practice location:
  • Phone: 386-294-1321
  • Fax: 386-294-3876
Mailing address:
  • Phone: 386-362-2708
  • Fax: 386-362-6301

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. KERRY S WALDRON
Title or Position: ADMINISTRATOR
Credential:
Phone: 386-362-2708