Organization
PUNTA GORDA HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
NEUROLOGY CENTER OF SOUTHWEST FLORIDA, Punta Gorda 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
713 E MARION AVE STE 129, PUNTA GORDA, FL 33950-3868
(941) 833-1580
(941) 621-8977
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
2084N0400X
Neurology Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278522610
—
FL
Enumeration date
07/23/2021
Last updated
03/16/2022
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