MEDICARE: FLORIDA MEDICAL PRACTICE PLAN INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103G00000X	Clinical Neuropsychologist
2	170300000X	Genetic Counselor (M.S.)
3	207R00000X	Internal Medicine Physician
4	207RG0300X	Geriatric Medicine (Internal Medicine) Physician
5	2084P0800X	Psychiatry Physician
6	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1629947346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA MEDICAL PRACTICE PLAN INC

Provider Business Mailing Address
First Line	:	2390 PHILLIPS RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5326
Country	:	US
Telephone Number	:	850-645-9451
Fax Number	:

Provider Business Practice Location Address
First Line	:	2390 PHILLIPS RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5326
Country	:	US
Telephone Number	:	850-645-9451
Fax Number	:

Authorized Official
Title or Position	:	HEAD OF CLINICAL OPERATIONS
Name	:	PATRICIA BALLANTINE
Credential	:
Telephone Number	:	850-645-9451

Provider Enumeration Date	:	10/31/2025
Last Update Date	:	03/10/2026

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