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

Space Coast Family Practice

Organization Clinic/Center · NPI 1811099054

Space Coast Family Practice is a Clinic/Center in Green Bay, Wisconsin. Licensed in Florida. Registered with an NPI since 2006.

Licensed in
FL
In the registry since
2006

Practice location Address checks out

3067 Windland Dr
Green Bay, WI 54311-7574
Phone: (920) 544-5868
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinic/Center (primary) Taxonomy 261Q00000X · Licence ME88311 (FL)

Record details

NPI number1811099054
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Thomas Betka — President · (920) 544-5868
NPI enumeratedSeptember 1, 2006
Last updated in NPPESAugust 22, 2020
Mailing address3067 Windland Dr, Green Bay, WI 54311-7574

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