Provider Demographics
NPI:1780650879
Name:FLORIDA DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:FLORIDA DEPARTMENT OF HEALTH
Other - Org Name:HARDEE COUNTY HELATH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FISCAL ASSISTANT II
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:DELILAH
Authorized Official - Last Name:MISHOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-473-6073
Mailing Address - Street 1:115 K D REVELL RD
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-2051
Mailing Address - Country:US
Mailing Address - Phone:863-773-4161
Mailing Address - Fax:863-773-0978
Practice Address - Street 1:115 K D REVELL RD
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873
Practice Address - Country:US
Practice Address - Phone:863-773-4161
Practice Address - Fax:863-773-0978
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA DEPARTMENT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-27
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH8202OtherRAILROAD MEDICARE
FL027935800Medicaid
FL027935804Medicaid
FL99130OtherBC/BS GROUP NUMBER
FL027935830Medicaid
FL027935803Medicaid
FL027935801Medicaid
FL027935802Medicaid
FL027935809Medicaid
FLCH8202OtherRAILROAD MEDICARE