Provider Demographics
NPI:1386189520
Name:FLORIDA HOSPITAL CELEBRATION HEALTH
Entity Type:Organization
Organization Name:FLORIDA HOSPITAL CELEBRATION HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:MELODY
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:863-420-3037
Mailing Address - Street 1:1454 LAKE SIDE AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-1716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1454 LAKE SIDE AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-1716
Practice Address - Country:US
Practice Address - Phone:863-420-3037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-26
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9327498282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital