Provider Demographics
NPI:1326044793
Name:COUNTY OF HERNANDO BOARD OF COUNTY COMMISSIONERS
Entity Type:Organization
Organization Name:COUNTY OF HERNANDO BOARD OF COUNTY COMMISSIONERS
Other - Org Name:HERNANDO COUNTY FIRE RESCUE DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-540-4353
Mailing Address - Street 1:15470 FLIGHT PATH DR
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-6823
Mailing Address - Country:US
Mailing Address - Phone:352-540-4353
Mailing Address - Fax:352-540-4355
Practice Address - Street 1:60 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601
Practice Address - Country:US
Practice Address - Phone:352-540-4353
Practice Address - Fax:352-540-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL400076500Medicaid
FL159292100OtherUS DEPT OF LABOR
FLA0726OtherBLUE CROSS PROVIDER #