Provider Demographics
NPI:1629259940
Name:FLORIDA DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:FLORIDA DEPARTMENT OF HEALTH
Other - Org Name:FLORIDA DEPARTMENT OF HEALTH LIBERTY COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHARBONNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:850-643-2415
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-0489
Mailing Address - Country:US
Mailing Address - Phone:850-643-2415
Mailing Address - Fax:850-643-5689
Practice Address - Street 1:12832 NW CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321
Practice Address - Country:US
Practice Address - Phone:850-643-2415
Practice Address - Fax:850-643-5689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal