Provider Demographics
NPI:1992737043
Name:GALEN OF FLORIDA, INC
Entity type:Organization
Organization Name:GALEN OF FLORIDA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FULKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-341-4806
Mailing Address - Street 1:6500 38TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1629
Mailing Address - Country:US
Mailing Address - Phone:727-341-4828
Mailing Address - Fax:727-341-4830
Practice Address - Street 1:6500 38TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1629
Practice Address - Country:US
Practice Address - Phone:727-341-4828
Practice Address - Fax:727-341-4830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. PETERSBURG GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-07
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1992737043OtherNPI
FL1020680005Medicare ID - Type UnspecifiedPROVIDER NUMBER