Provider Demographics
NPI:1851350409
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:INTERIM ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-727-0542
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:FL
Mailing Address - Zip Code:32052-0267
Mailing Address - Country:US
Mailing Address - Phone:386-792-1414
Mailing Address - Fax:386-792-2352
Practice Address - Street 1:209 CENTRAL AVE SE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:FL
Practice Address - Zip Code:32052-6153
Practice Address - Country:US
Practice Address - Phone:386-792-1414
Practice Address - Fax:386-792-2352
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA DEPARTMENT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-22
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027934000Medicaid
K4118Medicare PIN