Provider Demographics
NPI:1144551748
Name:SEMINOLE TRIBE OF FLORIDA HEALTH DEPT.
Entity type:Organization
Organization Name:SEMINOLE TRIBE OF FLORIDA HEALTH DEPT.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR SEMINOLE TRIBE OF F
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHIDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:954-962-2009
Mailing Address - Street 1:3006 JOSIE BILLIE AVE.
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024
Mailing Address - Country:US
Mailing Address - Phone:954-262-2009
Mailing Address - Fax:954-985-8456
Practice Address - Street 1:3006 JOSIE BILLIE AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-962-2009
Practice Address - Fax:954-985-8456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3083592261QP0904X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal