Provider Demographics
NPI:1629947346
Name:FLORIDA MEDICAL PRACTICE PLAN INC
Entity type:Organization
Organization Name:FLORIDA MEDICAL PRACTICE PLAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLANTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-645-9451
Mailing Address - Street 1:2390 PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5326
Mailing Address - Country:US
Mailing Address - Phone:850-645-9451
Mailing Address - Fax:
Practice Address - Street 1:2390 PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5326
Practice Address - Country:US
Practice Address - Phone:850-645-9451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA MEDICAL PRACTICE PLAN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-31
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty