Provider Demographics
NPI:1558468991
Name:POLK COUNTY BOARD OF COUNTY COMMISSIONERS
Entity Type:Organization
Organization Name:POLK COUNTY BOARD OF COUNTY COMMISSIONERS
Other - Org Name:EMPLOYEE HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-534-5266
Mailing Address - Street 1:2010 E GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-6709
Mailing Address - Country:US
Mailing Address - Phone:863-534-5280
Mailing Address - Fax:863-534-5278
Practice Address - Street 1:2010 E GEORGIA ST
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-6709
Practice Address - Country:US
Practice Address - Phone:863-534-5280
Practice Address - Fax:863-534-5278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3222322363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational HealthGroup - Single Specialty