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Organization
GULF COAST HMA PHYSICIAN MANAGEMENT LLC
Active
Organization
GULF COAST HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Gulf Coast HMA Physician Management LLC, Gulf Coast Medical Group Internal Medicine Tuscany
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
1720 E VENICE AVE FL 1, VENICE, FL 34292-3190
(941) 483-9700
(941) 483-9715
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277033409
—
FL
Enumeration date
07/16/2021
Last updated
03/15/2022
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