# PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Port Charlotte HMA Physician Management LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659039311
- **Authorized official:** JENNIFER L JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
- **Authorized official phone:** (615) 465-3334

## Contact information

- **Practice address:** 2400 HARBOR BLVD STE 7, PORT CHARLOTTE, FL 33952-5038
- **Practice address phone:** (941) 766-5099
- **Practice address fax:** (941) 766-4884
- **Mailing address:** PO BOX 689022, FRANKLIN, TN 37068-9022
- **Mailing address phone:** (615) 465-7211

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | — | NULL | — |
| 207RG0100X | Gastroenterology Physician | — | — | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |
| 363LA2100X | Acute Care Nurse Practitioner | — | NULL | — |
| 363LA2100X | Acute Care Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 11/30/2021
- **Last updated:** 05/25/2022

## Other identifiers

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