Florida Department of Health
Organization Active NPI Public Health or Welfare Agency · St Augustine, FL
NPI 1023081932 · NPPES record last updated Apr 18, 2024
Key facts
- NPI
- 1023081932
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Public Health or Welfare Agency 251K00000X
- Legal business name
- FLORIDA DEPARTMENT OF HEALTH
- Practice address
- 200 San Sebastian VW
St Augustine, FL 32084-8695 - Phone
- (904) 506-6081
- Fax
- (904) 825-6875
- NPI assigned
- Feb 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Shane Lockwood
- Title
- Health Officer
- Phone
- (904) 506-6153
Practitioners 12
-
Monique M. Berces-Mardenly, FNP, MSN, MPH
-
Ulyee Choe, D.O.
-
Alicia Cosma Gilbert, FNP
-
Vivek M Manikal, MD
-
Kerrie Peacock-Preston, PA-C
-
Andrea Sciberras, D.O.
-
Victoria Yarbrough, APRN
-
Wynde Goins, PA-C
-
Bruce H Kraut, M.D.
-
Tracy Montoya, RDH
-
Kerry Whitaker, P.A.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D0884169 | Florida Department of Health in St Johns County | Certificate of waiver | Apr 11, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Walton Community Health Center |
Federally qualified health center | Operational/Managerial Control (100%) | Sep 7, 2010 |
| Bradford Community Health Care Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 1, 2013 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040724000002 | FL | Part B Supplier - Clinic/Group Practice | 3072424282 |
Receives reassigned benefits from 10 practitioners Practice locations: Saint Augustine, FL |
National Provider Directory
Locations
200 San Sebastian Vw
Ste 1322
Saint Augustine, FL 32084
200 San Sebastian Vw
St Augustine, FL 32084
Phone (904) 209-3250
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | Yes |
Addresses
Primary practice location
200 San Sebastian VW
St Augustine, FL 32084-8695
Mailing address
200 San Sebastian VW
St Augustine, FL 32084-8695
Phone (904) 506-6081
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 027965000 | Medicaid | FL | |
| 6000002143 | Other | FL | RAILROAD MEDICARE NUMBER |
| 99309 | Other | FL | MEDICARE GROUP ID |
Other names
- St Johns County Health Department
Other providers in St Augustine, FL
- Julie Lynn Flick
- Flo Yoga Spa
- Florida Autism Center
- Florida Center for Dermatology, P.a.
- Florida Center for TMS
- Florida Department of Veterans Affairs
- Florida Department of Veterans' Affairs
- Florida Em-I Medical Services PA
- Florida First Assistants, Inc.
- Florida Health Care Plan, Inc
All providers in St Augustine, FL · Public Health or Welfare Agency in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.