Florida Department of Health
Organization Active NPI Public Health or Welfare Agency · Daytona Beach, FL
NPI 1831158039 · NPPES record last updated Oct 14, 2024
Key facts
- NPI
- 1831158039
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Public Health or Welfare Agency 251K00000X
- Legal business name
- FLORIDA DEPARTMENT OF HEALTH
- Practice address
- 1845 Holsonback Dr
Daytona Beach, FL 32117-5114 - Phone
- (386) 274-0500
- Fax
- (386) 274-0800
- NPI assigned
- Mar 17, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- FLORIDA DEPARTMENT OF HEALTH
Authorized official
- Name
- Stephen Civitelli, RS, MPH
- Title
- Administrator/Health Officer
- Phone
- (386) 274-0800
Corporate family (same tax ID) 24
Practitioners 16
-
Megan Bagwell, MD
-
Brittany C Gaskin, APRN
-
Meena A Joseph, M.D.
-
Madhavi Kondur Muppala, M.D.
-
Thomas Lee, ARNP
-
Cathy Lynn Frazier, ARNP
-
Sandra E Crow, LPN
-
Catreena Harris, LPN
-
Fay L Prince, RN
-
Marjory W Quammie, ARNP
-
Yolanda Sullivan, RN
-
Nancy J Tremblay, RN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D0685475 | Volusia County Health Department | Provider-performed microscopy | Sep 4, 2026 |
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 |
|---|---|---|---|---|
| O20050331001167 | FL | Part B Supplier - Clinic/Group Practice | 3072424282 |
Receives reassigned benefits from 9 practitioners Practice locations: Orange City, FL; New Smyrna Beach, FL; Daytona Beach, FL |
National Provider Directory
- Tax ID family
- Dept of Health Central Pharmacy
- Part of
- Dept of Health Central Pharmacy
Locations
931 N Spring Garden Ave
Deland, FL 32720
Phone (386) 274-0500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | Yes |
Addresses
Primary practice location
1845 Holsonback Dr
Daytona Beach, FL 32117-5114
Mailing address
PO Box 9190
Daytona Beach, FL 32120-9190
Phone (386) 274-0500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 027974900 | Medicaid | FL |
Other names
- Volusia County Health Department
Other providers in Daytona Beach, FL
- Kristine Faye Fletcher
- Jens Baggesen Flock IV
- Abigail Flores
- Florida Autism Center
- Florida Cancer Specialists & Research Institute, LLC
- Florida Department of Veterans Affairs
- Florida Department of Veterans Affairs
- Florida Em-I Medical Services PA
- Florida Endovascular Specialists LLC
- Florida Essential Living
All providers in Daytona Beach, 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 Oct 14, 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.