MEDICARE: FAMILY CARE PARTNERS OF NORTHEAST FLORIDA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1114529856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CARE PARTNERS OF NORTHEAST FLORIDA LLC

Provider Business Mailing Address
First Line	:	425 W COLONIAL DR STE 303
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-6863
Country	:	US
Telephone Number	:	904-745-3618
Fax Number	:	904-722-4271

Provider Business Practice Location Address
First Line	:	14444 BEACH BLVD STE 28
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-2080
Country	:	US
Telephone Number	:	903-367-2277
Fax Number	:	904-421-3788

Authorized Official
Title or Position	:	CFO
Name	:	DAVID BROWN
Credential	:
Telephone Number	:	833-702-8383

Provider Enumeration Date	:	11/09/2020
Last Update Date	:	01/03/2025

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