Provider Demographics
NPI:1710949318
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:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:850-614-6060
Mailing Address - Street 1:603 SCENIC CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-3060
Mailing Address - Country:US
Mailing Address - Phone:850-547-8500
Mailing Address - Fax:850-547-8515
Practice Address - Street 1:603 SCENIC CIRCLE
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425
Practice Address - Country:US
Practice Address - Phone:850-547-8500
Practice Address - Fax:850-547-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051902202Medicaid
FL051902200Medicaid
FL051902200Medicaid
FL051902200Medicaid