Healthcare Provider Details

I. General information

NPI: 1396364899
Provider Name (Legal Business Name): PARTNERS FAMILY MEDICINE PRACTICE & RECOVERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4453 HIGHWAY 90
PACE FL
32571-2066
US

IV. Provider business mailing address

5264 EMERALD DR
PACE FL
32571-9067
US

V. Phone/Fax

Practice location:
  • Phone: 850-905-0110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA MAUPIN
Title or Position: OWNER
Credential:
Phone: 850-905-0110