Healthcare Provider Details

I. General information

NPI: 1558339028
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86014 PAGES DAIRY ROAD
YULEE FL
32097
US

IV. Provider business mailing address

30 S 4TH ST
FERNANDINA BEACH FL
32034-4272
US

V. Phone/Fax

Practice location:
  • Phone: 904-548-1880
  • Fax: 904-225-0850
Mailing address:
  • Phone: 904-548-1800
  • Fax: 904-277-7286

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: CARE GLUCK
Title or Position: HEALTH ADMINISTRATOR/HEALTH OFFICER
Credential:
Phone: 904-753-1231