Healthcare Provider Details

I. General information

NPI: 1023081932
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SAN SEBASTIAN VW
ST AUGUSTINE FL
32084-8695
US

IV. Provider business mailing address

200 SAN SEBASTIAN VW
ST AUGUSTINE FL
32084-8695
US

V. Phone/Fax

Practice location:
  • Phone: 904-506-6081
  • Fax: 904-825-6875
Mailing address:
  • Phone: 904-506-6081
  • Fax: 904-825-6875

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: SHANE LOCKWOOD
Title or Position: HEALTH OFFICER
Credential:
Phone: 904-506-6153