Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Southlake Family Practice PA

Organization Primary Care Clinic/Center · NPI 1225247810

Southlake Family Practice PA is a Primary Care Clinic/Center in St Augustine, Florida. Licensed in Florida. Registered with an NPI since 2007.

Licensed in
FL
In the registry since
2007
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

308 Kingsley Lake Dr Ste 802
St Augustine, FL 32092-3046
Phone: (904) 827-0788
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Primary Care Clinic/Center (primary) Taxonomy 261QP2300X · Licence ME79394 (FL)

Record details

NPI number1225247810
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Malgorzata Kaluza — Medical Director · (904) 827-0788
NPI enumeratedMay 21, 2007
Last updated in NPPESSeptember 29, 2011
Mailing address308 Kingsley Lake Dr Ste 802, St Augustine, FL 32092-3046

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