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Organization
PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC
Active
Organization
PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR DIR ENROLLMENT & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
713 E MARION AVE STE 123, PUNTA GORDA, FL 33950-3862
(941) 766-5099
(961) 764-0194
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
NULL
2086S0129X
Vascular Surgery Physician
Primary
—
—
363LG0600X
Gerontology Nurse Practitioner
—
NULL
363LG0600X
Gerontology Nurse Practitioner
—
—
Other
Enumeration date
10/11/2022
Last updated
10/11/2022
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