Provider Demographics
NPI:1376502088
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:EXECUTIVE COMM HEALTH NURSING DIREC
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MSN RN
Authorized Official - Phone:850-833-9075
Mailing Address - Street 1:221 HOSPITAL DRIVE, N.E.
Mailing Address - Street 2:COUNTY HEALTH DEPT.
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-0000
Mailing Address - Country:US
Mailing Address - Phone:850-833-9240
Mailing Address - Fax:850-833-9252
Practice Address - Street 1:221 HOSPITAL DRIVE, N.E.
Practice Address - Street 2:COUNTY HEALTH DEPT.
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548
Practice Address - Country:US
Practice Address - Phone:850-833-9240
Practice Address - Fax:850-833-9252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027956100Medicaid