Healthcare Provider Details

I. General information

NPI: 1467964494
Provider Name (Legal Business Name): FLORIDA HEALTH CARE PLAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOUTHPARK BLVD STE 206
ST AUGUSTINE FL
32086-3129
US

IV. Provider business mailing address

2450 MASON AVE
DAYTONA BEACH FL
32114-5110
US

V. Phone/Fax

Practice location:
  • Phone: 904-295-3677
  • Fax: 904-295-3679
Mailing address:
  • Phone: 386-615-5008
  • Fax: 386-676-7165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License NumberPH31002
License Number StateFL

VIII. Authorized Official

Name: DR. CHRISTOPHER J SMITH
Title or Position: CMO
Credential:
Phone: 386-615-5008