Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Primary Care Center of Port Orange

Organization Family Medicine Physician · NPI 1295910834

Primary Care Center of Port Orange provides Family Medicine Physician services in Port Orange, Florida. Licensed in Florida. Registered with an NPI since 2008.

Licensed in
FL
In the registry since
2008

Practice location Address checks out

4770 S Ridgewood Ave Ste 1
Port Orange, FL 32127-4544 Not confirmed with CMS for 15 years — call before visiting
Phone: (386) 761-0050
Fax: (386) 761-1167
Show map & directions

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

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence ME0028054 (FL)

Record details

NPI number1295910834
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Michelle Jackson — Office Manager · (386) 761-0050
NPI enumeratedJanuary 2, 2008
Last updated in NPPESMarch 29, 2011
Mailing address4770 S Ridgewood Ave, Suite 1, Port Orange, FL 32127-4544

Other providers in Port Orange