Organization
CENTRAL FLORIDA CHILD HEALTH PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CATHLEEN O. MARK (PROJECT ADMINISTRATOR)
(407) 858-6143
Entity
Organization
Contact information
Practice address
7040 LAKE ELLENOR DRIVE, ORLANDO, FL 32809-5750
(407) 858-6143
(407) 856-6594
Mailing address
7040 LAKE ELLENOR DRIVE, ORLANDO, FL 32809-5750
(407) 858-6143
(407) 856-6594
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
056105300
—
FL
Enumeration date
10/17/2006
Last updated
04/05/2011
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