Provider Demographics
NPI:1023081932
Name:FLORIDA DEPARTMENT OF HEALTH
Entity type:Organization
Organization Name:FLORIDA DEPARTMENT OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-506-6153
Mailing Address - Street 1:200 SAN SEBASTIAN VW
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-8695
Mailing Address - Country:US
Mailing Address - Phone:904-506-6081
Mailing Address - Fax:904-825-6875
Practice Address - Street 1:200 SAN SEBASTIAN VW
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-8695
Practice Address - Country:US
Practice Address - Phone:904-506-6081
Practice Address - Fax:904-825-6875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027965000Medicaid
FL6000002143OtherRAILROAD MEDICARE NUMBER
FL99309OtherMEDICARE GROUP ID
FL=========036OtherTRICARE NUMBER