# PUNTA GORDA HMA PHYSICIAN MANAGEMENT LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bayfront Health Medical Group Psychiatry, Punta Gorda HMA Physician Management LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740859552
- **Authorized official:** JENNIFER L JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
- **Authorized official phone:** (615) 465-3334

## Contact information

- **Practice address:** 713 E MARION AVE STE 121, PUNTA GORDA, FL 33950-3862
- **Practice address phone:** (941) 833-1760
- **Practice address fax:** (941) 205-3374
- **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 |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 2084N0400X | Neurology Physician | — | — | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 06/24/2021
- **Last updated:** 03/18/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 278522614 | — | FL |