MEDICARE: FLORIDA PRIMARY CARE AND SPORTS MEDICINE, INC.

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	261QP2300X	Primary Care Clinic/Center
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1548819741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA PRIMARY CARE AND SPORTS MEDICINE, INC.

Provider Business Mailing Address
First Line	:	6 OFFICE PARK DR
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-3808
Country	:	US
Telephone Number	:	386-447-6615
Fax Number	:	386-447-1266

Provider Business Practice Location Address
First Line	:	140 PINNACLES DR
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-2322
Country	:	US
Telephone Number	:	386-597-2829
Fax Number	:	386-313-1923

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ANN SHAW
Credential	:
Telephone Number	:	386-447-6615

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	07/01/2025

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