Provider Demographics
NPI:1205895752
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:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SABLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOLLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-498-1360
Mailing Address - Street 1:119 NE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-3428
Mailing Address - Country:US
Mailing Address - Phone:352-463-3120
Mailing Address - Fax:352-463-3124
Practice Address - Street 1:119 NE 1ST ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-3428
Practice Address - Country:US
Practice Address - Phone:352-463-3120
Practice Address - Fax:352-463-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027931500Medicaid
FL00202Medicare PIN