Provider Demographics
NPI:1639144033
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:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, BSN, RN
Authorized Official - Phone:407-665-3696
Mailing Address - Street 1:400 W AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-5489
Mailing Address - Country:US
Mailing Address - Phone:407-665-3000
Mailing Address - Fax:407-665-3213
Practice Address - Street 1:400 W AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-5489
Practice Address - Country:US
Practice Address - Phone:407-665-3000
Practice Address - Fax:407-665-3213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027969200Medicaid
FL027969290Medicaid
FL027969200Medicaid
FL99015Medicare PIN
FL027969201Medicaid
FL027969200Medicaid
FL99015Medicare PIN