Healthcare Provider Details

I. General information

NPI: 1780650879
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 K D REVELL RD
WAUCHULA FL
33873
US

IV. Provider business mailing address

115 K D REVELL RD
WAUCHULA FL
33873-2051
US

V. Phone/Fax

Practice location:
  • Phone: 863-773-4161
  • Fax: 863-773-0978
Mailing address:
  • Phone: 863-773-4161
  • Fax: 863-773-0978

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: EVELYN DELILAH MISHOE
Title or Position: FISCAL ASSISTANT II
Credential:
Phone: 863-473-6073