Provider Demographics
NPI:1164422747
Name:BOARD OF COUNTY COMMISSIONERS OF NASSAU COUNTY
Entity Type:Organization
Organization Name:BOARD OF COUNTY COMMISSIONERS OF NASSAU COUNTY
Other - Org Name:NASSAU COUNTY BOARD OF COUNTY COMMISSIONERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TACO
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-530-6010
Mailing Address - Street 1:96135 NASSAU PL STE 2
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-8635
Mailing Address - Country:US
Mailing Address - Phone:904-530-6030
Mailing Address - Fax:904-530-6903
Practice Address - Street 1:96160 NASSAU PL STE 1
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-8626
Practice Address - Country:US
Practice Address - Phone:904-530-6600
Practice Address - Fax:904-321-5748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3712341600000X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL159897600OtherUS DEPT OF LABOR
GAN413568OtherWELLCARE
GA000674858AOtherMEDICAID GEORGIA
FL406590904OtherRAILROAD MEDICARE
FL088086800Medicaid
GAN413568OtherWELLCARE