Organization
SANTA ROSA HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Santa Rosa 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
5978 BERRYHILL RD, MILTON, FL 32570-4009
(850) 626-6363
(850) 626-1414
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
374819710
—
FL
Enumeration date
06/09/2021
Last updated
03/16/2022
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