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Organization
PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC
Active
Organization
PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Bayfront Health Wound Care and Hyperbaric Center, 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
25097 OLYMPIA AVE STE 107, PUNTA GORDA, FL 33950-3914
(941) 205-2620
(941) 235-2347
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
FL
Enumeration date
07/07/2021
Last updated
03/16/2022
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