MEDICARE: CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1508531229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	4930 E LAKE MARY BLVD
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-5003
Country	:	US
Telephone Number	:	407-322-8645
Fax Number	:	407-269-8986

Provider Business Practice Location Address
First Line	:	1120 STATE ROAD 436 STE 1600
Second Line	:
City	:	CASSELBERRY
State	:	FL
Zip	:	32707-6182
Country	:	US
Telephone Number	:	407-322-8645
Fax Number	:	407-269-8986

Authorized Official
Title or Position	:	CEO
Name	:	JANELLE ALYCEE DUNN
Credential	:
Telephone Number	:	321-377-3666

Provider Enumeration Date	:	08/13/2021
Last Update Date	:	08/13/2021

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