Healthcare Provider Details

I. General information

NPI: 1205895752
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 NE 1ST ST
TRENTON FL
32693-3428
US

IV. Provider business mailing address

119 NE 1ST ST
TRENTON FL
32693-3428
US

V. Phone/Fax

Practice location:
  • Phone: 352-463-3120
  • Fax: 352-463-3124
Mailing address:
  • Phone: 352-463-3120
  • Fax: 352-463-3124

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: SABLE S BOLLING
Title or Position: ADMINISTRATOR
Credential:
Phone: 352-498-1360