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Organization
GULF COAST HMA PHYSICIAN MANAGEMENT LLC
Active
Organization
GULF COAST HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Gulf Coast Medical Group North Port Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR DR PROV ENROLLMENT & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
18659 TAMIAMI TRL STE A, NORTH PORT, FL 34287-7388
(941) 429-3416
(941) 429-3430
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207RG0100X
Gastroenterology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207RR0500X
Rheumatology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208600000X
Surgery Physician
—
—
213E00000X
Podiatrist
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
FL
Enumeration date
09/03/2021
Last updated
03/14/2022
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