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Organization
SANTA ROSA HMA PHYSICIAN MANAGEMENT LLC
Active
Organization
SANTA ROSA HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Santa Rosa HMA Physician Management LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR DIR ONBOARDING & PROV ENROLLMENT)
(615) 465-3334
Entity
Organization
Contact information
Practice address
4225 WOODBINE RD STE G, MILTON, FL 32571-8791
(850) 994-6575
(850) 994-5643
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(877) 892-9815
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
FL
Enumeration date
12/10/2021
Last updated
03/16/2022
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