# COLLIER BOULEVARD HMA PHYSICIAN MANAGEMENT LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Collier Boulevard HMA Physician Management LLC, Physicians Regional - Bonita Springs
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134797202
- **Authorized official:** JENNIFER L JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
- **Authorized official phone:** (615) 465-3334

## Contact information

- **Practice address:** 24231 WALDEN CENTER DR STE 201, BONITA SPRINGS, FL 34134-5012
- **Practice address phone:** (239) 348-4221
- **Practice address fax:** (239) 390-2486
- **Mailing address:** PO BOX 689022, FRANKLIN, TN 37068-9022
- **Mailing address phone:** (615) 465-7211
- **Mailing address fax:** (615) 628-6877

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/15/2021
- **Last updated:** 03/09/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001609609 | — | FL |