| Details | Last Recertification Date | Update | Recertification | 5/8/2024 9:26:11 AM | 5/5/2025 11:47:36 AM | 5/5/2025 11:47 AM |
| Details | Last Recertification Date | Update | Recertification | 5/8/2023 1:04:50 PM | 5/8/2024 9:26:11 AM | 5/8/2024 9:26 AM |
| Contacts | Primary Contact | Update | Change Request | Tomlins, Elena Eastman
Executive Community Health Nursing Director
Florida Department of Health in Charlotte County
9416247200-7257 | Tomlins, Elena Eastman
Executive Community Health Nursing Director
Florida Department of Health Charlotte County
9416247200-7257 | 5/9/2023 8:28 AM |
| Details | Last Recertification Date | Update | Recertification | 5/9/2022 7:57:57 AM | 5/8/2023 1:04:50 PM | 5/8/2023 1:04 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | PEPE, JOSEPH D
CHD ADMINISTRATOR
Florida Department of Health
8636744041-120 | PEPE, JOSEPH D
CHD ADMINISTRATOR
Florida Department of Health
9416247255 | 5/8/2023 1:03 PM |
| Details | Last Recertification Date | Update | Recertification | 5/13/2021 6:37:09 AM | 5/9/2022 7:57:57 AM | 5/9/2022 7:57 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Eastman, Elena A
Executive Community Health Nursing Director
Florida Department of Health in Charlotte County
9416247200-7257 | Tomlins, Elena Eastman
Executive Community Health Nursing Director
Florida Department of Health in Charlotte County
9416247200-7257 | 4/12/2022 1:37 PM |
| Details | Nature of Support: Support Received From Date | Update | Recertification | | 1/1/2021 12:00:00 AM | 5/13/2021 6:37 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | FL | 5/13/2021 6:37 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | FL | 5/13/2021 6:37 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | FL | 5/13/2021 6:37 AM |
| Details | Last Recertification Date | Update | Recertification | 5/6/2020 7:15:21 PM | 5/13/2021 6:37:09 AM | 5/13/2021 6:37 AM |
| Details | NOFO Number | Update | Recertification | | NOFO: CDC-RFA-PS19-1901 | 5/13/2021 6:37 AM |
| Details | Last Recertification Date | Update | Recertification | 5/14/2019 10:43:53 AM | 5/6/2020 7:15:21 PM | 5/6/2020 7:15 PM |
| Details | Grant Number | Update | Change Request | NH25PS005131 | H25PS005131 | 8/5/2019 9:18 AM |
| Details | Grant Number | Update | Change Request | STD-FL | NH25PS005131 | 6/7/2019 9:10 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Eastman, Elena A
Sr. Community Health Nursing Supervisor
Florida Department of Health in Charlotte County
9416247200-7240 | Eastman, Elena A
Executive Community Health Nursing Director
Florida Department of Health in Charlotte County
9416247200-7257 | 5/20/2019 10:58 AM |
| Details | Last Recertification Date | Update | Recertification | 4/27/2018 9:52:06 AM | 5/14/2019 10:43:53 AM | 5/14/2019 10:43 AM |
| Details | Last Recertification Date | Update | Recertification | 5/3/2017 12:00:00 AM | 4/27/2018 9:52:06 AM | 4/27/2018 9:52 AM |
| Contacts | Authorizing Official | Update | Change Request | Lepore, Frank Louis
Health Officer
DOH-Charlotte
9416247255 | PEPE, JOSEPH D
CHD ADMINISTRATOR
Florida Department of Health
8636744041-120 | 4/4/2018 12:28 PM |
| Contacts | Primary Contact | Update | Change Request | Perez, Alberto
Financial Administrator
9416247200-7263 | Eastman, Elena A
Sr. Community Health Nursing Supervisor
Florida Department of Health in Charlotte County
9416247200-7240 | 2/20/2018 3:33 PM |
| Contacts | Authorizing Official | Update | | Lepore, Frank Louis
Health Officer
9416247255 | Lepore, Frank Louis
Health Officer
DOH-Charlotte
9416247255 | 2/20/2018 3:29 PM |
| Addresses | Main Address | Insert | | |
1100 Loveland Blvd
Port Charlotte, FL 33980-1802 | 5/3/2017 11:32 AM |
| Contacts | Authorizing Official | Update | | Burns, Mary Kay
CHD Administrator
8639934601-118 | Lepore, Frank Louis
Health Officer
9416247255 | 5/3/2017 11:32 AM |
| Contacts | Signed By | Insert | | | Burns, Mary Kay
Interim Administrator
9416247200-7255 | 5/3/2017 11:32 AM |
| Contacts | Primary Contact | Insert | | | Perez, Alberto
Financial Administrator
9416247200-7263 | 5/3/2017 11:32 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1750556130 | 5/3/2017 11:31 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1730194374 | 5/3/2017 11:31 AM |
| Details | Last Recertification Date | Update | | 2/12/2016 12:00:00 AM | 5/3/2017 12:00:00 AM | 5/3/2017 11:31 AM |
| Contacts | Authorizing Official | Insert | | | Burns, Mary Kay
CHD Administrator
8639934601-118 | 2/14/2017 11:21 AM |
| Details | Last Recertification Date | Update | | 2/2/2015 12:00:00 AM | 2/12/2016 12:00:00 AM | 2/12/2016 3:36 PM |
| Details | Nature Of Support | Insert | | | Direct Funding (dollars received from CDC or an intermediate organization) | 2/2/2015 9:54 PM |
| Details | Last Recertification Date | Update | | 2/12/2014 12:00:00 AM | 2/2/2015 12:00:00 AM | 2/2/2015 9:54 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 2/12/2014 11:27 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 052044600 | 2/12/2014 11:27 AM |
| Medicaid Billing | Medicaid: State | Insert | | | FL | 2/12/2014 11:27 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1245354943 | 2/12/2014 11:27 AM |
| Details | Last Recertification Date | Update | | | 2/12/2014 12:00:00 AM | 2/12/2014 11:27 AM |
| Details | 340B ID | Update | | IS-AP-STD33980 | STD33980 | 7/12/2012 4:55 PM |
| Dates | Participating Approval Date | Update | | | 7/12/2012 12:00:00 AM | 7/12/2012 4:55 PM |
| Details | State | Update | | Pending | Active | 7/12/2012 4:55 PM |
| Dates | Start Date | Update | | | 10/1/2012 12:00:00 AM | 7/12/2012 4:55 PM |
| Details | Grant Number | Update | | | STD-FL | 7/11/2012 11:32 AM |
| Details | 340B ID | Update | | AP071112A | IS-AP-STD33980 | 7/11/2012 11:32 AM |
| Details | 340B ID | Update | | ONLINE_REG | AP071112A | 7/11/2012 10:22 AM |
| Details | Last Recertification Date | Insert | | | | 7/11/2012 9:31 AM |
| Details | Grant Number | Insert | | | | 7/11/2012 9:31 AM |
| Details | 340B ID | Insert | | | ONLINE_REG | 7/11/2012 9:31 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 7/11/2012 9:31 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/11/2012 9:31 AM |
| Details | Medicare Provider Number | Insert | | | | 7/11/2012 9:31 AM |
| Details | Entity Name | Insert | | | Charlotte County Health Department | 7/11/2012 9:31 AM |
| Details | Program Code | Insert | | | STD | 7/11/2012 9:31 AM |
| Details | Entity Subname | Insert | | | Port Charlotte STD Clinic | 7/11/2012 9:31 AM |
| Dates | Participating Approval Date | Insert | | | | 7/11/2012 9:31 AM |
| Details | State | Insert | | | Pending | 7/11/2012 9:31 AM |
| Dates | Registration Date | Insert | | | 7/11/2012 12:00:00 AM | 7/11/2012 9:31 AM |
| Dates | Signed By Date | Insert | | | 7/11/2012 12:00:00 AM | 7/11/2012 9:31 AM |
| Dates | Start Date | Insert | | | | 7/11/2012 9:31 AM |
| Terminations | Termination Comments | Insert | | | | 7/11/2012 9:31 AM |
| Terminations | Termination Date | Insert | | | | 7/11/2012 9:31 AM |
| Terminations | Termination Effective Date | Insert | | | | 7/11/2012 9:31 AM |
| Terminations | Termination Reason | Insert | | | | 7/11/2012 9:31 AM |