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Get Fl Ahca Form 2200-0003 2004-2025

Ded Secondary Specialty Code Name of Approved Training Program Location of Program (City) Date(s) Attended 12. (ST) to License Information Professional License Number Facility License Number CLIA License Number 13. NPI Number 14. Medicare Number 15. Provider Handbooks: And / Or UPI Number Check here if you wish to receive handbooks by mail NOTE: Up-to-date Medicaid provider handbooks are available for no charge on the fiscal agent web site (http://floridamedicaid.acs-inc.com). Copi.

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