# FLORIDA PRIMARY CARE AND SPORTS MEDICINE, INC.

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

## Provider details

- **NPI number:** 1548819741
- **Authorized official:** ANN SHAW (ADMINISTRATOR)
- **Authorized official phone:** (386) 447-6615

## Contact information

- **Practice address:** 140 PINNACLES DR, PALM COAST, FL 32164-2322
- **Practice address phone:** (386) 597-2829
- **Practice address fax:** (386) 313-1923
- **Mailing address:** 6 OFFICE PARK DR, PALM COAST, FL 32137-3808
- **Mailing address phone:** (386) 447-6615
- **Mailing address fax:** (386) 447-1266

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 09/10/2019
- **Last updated:** 07/01/2025