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Organization
PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC
Active
Organization
PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
COMPREHENSIVE WOMEN'S HEALTH CARE OF ARCADIA, Port Charlotte HMA Physician Management LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
1012 N MILLS AVE, ARCADIA, FL 34266-8811
(941) 766-0400
(941) 766-1009
Mailing address
1012 N MILLS AVE, ARCADIA, FL 34266-8811
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
NULL
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
—
NULL
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102610201
—
FL
Enumeration date
06/18/2021
Last updated
03/16/2022
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