Provider Demographics
NPI:1669440871
Name:DOH LEON COUNTY
Entity Type:Organization
Organization Name:DOH LEON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LONOGAN
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:R,N, BSN
Authorized Official - Phone:850-487-3186
Mailing Address - Street 1:3832 WINDERMERE ROAD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311
Mailing Address - Country:US
Mailing Address - Phone:850-877-7327
Mailing Address - Fax:850-487-3954
Practice Address - Street 1:3832 WINDERMERE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-9491
Practice Address - Country:US
Practice Address - Phone:850-877-7327
Practice Address - Fax:850-487-3954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9035099251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare