MEDICARE: FLORIDA DEPARTMENT OF HEALTH

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	251K00000X	Public Health or Welfare Agency

Other Identifiers

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

General Provider Information

NPI Number	:	1790746535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA DEPARTMENT OF HEALTH

Provider Business Mailing Address
First Line	:	362 STATE HIGHWAY 83
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32433-3800
Country	:	US
Telephone Number	:	850-892-8015
Fax Number	:	850-892-8024

Provider Business Practice Location Address
First Line	:	362 STATE HIGHWAY 83
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32433-3800
Country	:	US
Telephone Number	:	850-892-8015
Fax Number	:	850-892-8024

Authorized Official
Title or Position	:	MANAGEMENT ANALYST
Name	:	MRS. HARRIET A SIMMONS
Credential	:
Telephone Number	:	850-892-8015

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	03/25/2011

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Directions to “FLORIDA DEPARTMENT OF HEALTH ” Practice Location

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