Provider Demographics
NPI:1467694810
Name:FLORIDA DEPARTMENT OF HEALTH CITRUS COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:FLORIDA DEPARTMENT OF HEALTH CITRUS COUNTY HEALTH DEPARTMENT
Other - Org Name:CITRUS COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ARNP
Authorized Official - Phone:352-527-0068
Mailing Address - Street 1:3700 W SOVEREIGN PATH
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-8071
Mailing Address - Country:US
Mailing Address - Phone:352-527-0068
Mailing Address - Fax:352-527-8858
Practice Address - Street 1:3700 W SOVEREIGN PATH
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-8071
Practice Address - Country:US
Practice Address - Phone:352-527-0068
Practice Address - Fax:352-527-8858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027919601Medicaid
FL027919600Medicaid