Healthcare Provider Details

I. General information

NPI: 1609849660
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 W 11TH ST
PANAMA CITY FL
32401-2330
US

IV. Provider business mailing address

597 W 11TH ST
PANAMA CITY FL
32401-2330
US

V. Phone/Fax

Practice location:
  • Phone: 850-872-4455
  • Fax: 850-747-5475
Mailing address:
  • Phone: 850-872-4455
  • Fax: 850-747-5475

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. DOUGLAS KENT
Title or Position: ADMINISTRATOR
Credential:
Phone: 850-872-4455