Healthcare Provider Details

I. General information

NPI: 1407828189
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 GARRISON AVE
PORT ST JOE FL
32456-5265
US

IV. Provider business mailing address

2475 GARRISON AVE
PORT ST JOE FL
32456-5265
US

V. Phone/Fax

Practice location:
  • Phone: 850-227-1276
  • Fax: 850-227-1794
Mailing address:
  • Phone: 850-227-1276
  • Fax: 850-227-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number251K00000X
License Number StateFL

VIII. Authorized Official

Name: DOUGLAS MICHAEL KENT
Title or Position: CHIEF OPERATING OFFICER/ADMINISTRAT
Credential: M.P.H.
Phone: 850-227-1276