Provider Demographics
NPI:1770657678
Name:STATE OF FLORIDA DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:STATE OF FLORIDA DEPARTMENT OF HEALTH
Other - Org Name:FLAGLER COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:386-437-7350
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:301 S LEMON STREET
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-0847
Mailing Address - Country:US
Mailing Address - Phone:386-437-7350
Mailing Address - Fax:386-437-7353
Practice Address - Street 1:301 S LEMON ST
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-6212
Practice Address - Country:US
Practice Address - Phone:386-437-7350
Practice Address - Fax:386-437-7353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare