Provider Demographics
NPI:1073580890
Name:FLORIDA DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:FLORIDA DEPARTMENT OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:THAQI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-467-4700
Mailing Address - Street 1:780 SW 24TH STREET
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-2643
Mailing Address - Country:US
Mailing Address - Phone:954-467-4700
Mailing Address - Fax:954-467-4704
Practice Address - Street 1:780 SW 24TH STREET
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-2643
Practice Address - Country:US
Practice Address - Phone:954-467-4700
Practice Address - Fax:954-467-4704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
97885Medicare PIN
FL97885Medicare PIN