1780017699 NPI number — FLORIDA DEPARTMENT OF HEALTH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780017699 NPI number — FLORIDA DEPARTMENT OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA DEPARTMENT OF HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DUVAL COUNTY HEALTH DEPARTMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780017699
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 UNIVERSITY BLVD N
Provider Second Line Business Mailing Address:
MC-75
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32211-9230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-253-2062
Provider Business Mailing Address Fax Number:
904-253-1942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3225 UNIVERSITY BLVD S
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216-2762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-253-1120
Provider Business Practice Location Address Fax Number:
904-253-2514
Provider Enumeration Date:
08/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WELLS
Authorized Official First Name:
KELLI
Authorized Official Middle Name:
T
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
904-253-2062

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6905561-04 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6905561-09 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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