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NPI Code Detail

MEDICARE: FLORIDA DEPARTMENT OF VETERANS AFFAIRS

MEDICARE: FLORIDA DEPARTMENT OF VETERANS AFFAIRS
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
1314000000XSkilled Nursing FacilityFL
2311500000XAlzheimer Center (Dementia Center)FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518959667
Entity Type Code : Organization
Provider Name (Legal Business Name) : FLORIDA DEPARTMENT OF VETERANS AFFAIRS
Provider Business Mailing Address
First Line : 4419 TRAM RD
Second Line :
City : PANAMA CITY
State : FL
Zip : 32404-2559
Country : US
Telephone Number : 850-747-5401
Fax Number : 850-747-5301
Provider Business Practice Location Address
First Line : 4419 TRAM RD
Second Line :
City : PANAMA CITY
State : FL
Zip : 32404-2559
Country : US
Telephone Number : 850-747-5401
Fax Number : 850-747-5301
Authorized Official
Title or Position : PROGRAM DIRECTOR
Name : MR. WILLIAM G PUCKETT
Credential :
Telephone Number : 727-518-3202
Provider Enumeration Date : 08/16/2005
Last Update Date : 09/11/2025

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Directions to “FLORIDA DEPARTMENT OF VETERANS AFFAIRS ” Practice Location

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