| Southlake Family Practice Pa | |
|
308 Kingsley Lake Dr Ste 802 St Augustine FL 32092-3046 | |
| (904) 827-0788 | |
| Not Available |
| Full Name | Southlake Family Practice Pa |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 308 Kingsley Lake Dr Ste 802, St Augustine, Florida |
| Authorized Official Name and Position | Malgorzata Kaluza (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9048270788 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southlake Family Practice Pa 308 Kingsley Lake Dr Ste 802 St Augustine FL 32092-3046 Ph: (904) 827-0788 | Southlake Family Practice Pa 308 Kingsley Lake Dr Ste 802 St Augustine FL 32092-3046 Ph: (904) 827-0788 |
| NPI Number | 1225247810 |
|---|---|
| Provider Enumeration Date | 05/21/2007 |
| Last Update Date | 09/29/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225247810 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | ME79394 (Florida) | Primary |
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