Organization · Type 2 NPI

Florida Department of Health

Federal Public Health Clinic/Center · Bristol, FL

NPI number 1629259940 Active

Practice location

12832 NW Central Ave
Bristol, FL 32321

Call (850) 643-2415 Map

Fax (850) 643-5689

Mailing address

PO Box 489
Bristol, FL 32321-0489

Specialties and licenses

Taxonomy	Code	License
Federal Public Health Clinic/Center Primary	261QP0904X	None listed

Federal Public Health Clinic/Center: Definition to come...

10 other providers at this address

NPI record

NPI: 1629259940
Entity type: Organization (Type 2)
Issued: Nov 15, 2007
Last updated: Nov 28, 2007
Status: Active

Other names

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Florida Department of Health Liberty County Health Department · doing business as

Authorized official

Eugene G. Charbonneau, DO
Director
(850) 643-2415

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1629259940

Florida Department of Health's National Provider Identifier is 1629259940, issued on Nov 15, 2007. The primary taxonomy on file is Federal Public Health Clinic/Center (261QP0904X), and the practice location is in Bristol, FL. The record was last updated on Nov 28, 2007.