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Southlake Family Practice Pa
Primary Care Clinic/Center in St Augustine, Florida
NPI 1225247810

Southlake Family Practice Pa is a Primary Care Clinic/Center based in St Augustine, FL and is specialized in Primary Care. Southlake Family Practice Pa practices in St Augustine, FL. The NPI Number for Southlake Family Practice Pa is 1225247810 and holds a License No. ME79394 (Florida).

The current practice location address for Southlake Family Practice Pa is 308 Kingsley Lake Dr Ste 802, St Augustine, FL and can be reached out via phone at 904-827-0788.

Location: 308 Kingsley Lake Dr Ste 802, St Augustine, FL, 32092-3046
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1225247810
Provider Name
Southlake Family Practice Pa
Credential
Provider Entity Type
Organization
Address
308 Kingsley Lake Dr Ste 802, St Augustine, FL, 32092-3046
Phone Number
904-827-0788
Fax Number
Provider Enumeration Date
05/21/2007
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
308 Kingsley Lake Dr Ste 802
City
St Augustine
State
Florida
Zip
32092-3046
Phone Number
904-827-0788
Fax Number
person
Provider Business Mailing Address Details
Address
308 Kingsley Lake Dr Ste 802
City
St Augustine
State
Florida
Zip
32092-3046
Phone Number
904-827-0788
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Primary Care
Taxonomy
261QP2300X
License No.
ME79394 (Florida)
Definition
Definition to come...
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