Provider Demographics
NPI:1326205600
Name:WELLCARE OF FLORIDA, INC.
Entity Type:Organization
Organization Name:WELLCARE OF FLORIDA, INC.
Other - Org Name:STAYWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-206-1490
Mailing Address - Street 1:8735 HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1143
Mailing Address - Country:US
Mailing Address - Phone:813-290-6200
Mailing Address - Fax:
Practice Address - Street 1:3031 N. ROCKY POINT DRIVE W.
Practice Address - Street 2:SUITE 600
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-290-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLCARE HEALTH PLANS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-22
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015016909Medicaid
FL015016913Medicaid
FL015056801Medicaid
FL015016906Medicaid
FL015077102Medicaid
FL015016908Medicaid
FL015016912Medicaid
FL015016914Medicaid
FL015077100Medicaid
FL015077103Medicaid
FL015016901Medicaid
FL015016902Medicaid
FL015016907Medicaid
FL015077101Medicaid
FL015016903Medicaid
FL015016904Medicaid
FL015016905Medicaid
FL015016910Medicaid
FL015016911Medicaid
FL015056800Medicaid