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General NPI Number Information
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NPI Number | 1396732541
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Entity Type | Organization
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Legal Business Name | FLORIDA DEPARTMENT OF HEALTH
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Dates
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Enumeration Date | 10/03/2005
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 3241 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-2266
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Country | US
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Telephone | 863-413-2620
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Fax | 863-499-2612
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Provider Business Mailing Address
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Address Line | 1290 GOLFVIEW AVE ATTN: ACCOUNTS RECEIVABLES
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City | BARTOW
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State | FL
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Zip | 33830-6740
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Country | US
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Telephone | 863-519-7900
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Fax | 863-519-7696
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOY JACKSON
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Credential | MD
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Telephone | 863-519-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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