Organization
BROOKSVILLE HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Bayfront Health Medical Group
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
17222 HOSPITAL BLVD STE 116, BROOKSVILLE, FL 34601-8925
(352) 754-3565
(352) 606-2711
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
FL
Enumeration date
08/17/2021
Last updated
03/07/2022
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