# LAKE MARY FAMILY PHYSICIANS P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174719082
- **Authorized official:** MS. LEAH M SUTPHIN (BILLING MANAGER)
- **Authorized official phone:** (407) 829-8960

## Contact information

- **Practice address:** 910 WILLISTON PARK PT, SUITE 2050, LAKE MARY, FL 32746-2172
- **Practice address phone:** (407) 829-8960
- **Practice address fax:** (407) 829-8978
- **Mailing address:** 910 WILLISTON PARK PT, SUITE 2050, LAKE MARY, FL 32746-2172
- **Mailing address phone:** (407) 829-8960
- **Mailing address fax:** (407) 829-8978

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | ME88467, ME88578 | FL | Yes |
| 363L00000X | Nurse Practitioner | ARNP1103432 | FL | — |

## Other

- **Enumeration date:** 09/25/2007
- **Last updated:** 07/07/2009