Organization
SANTA ROSA HMA PHYSICIAN MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR DIRECTOR PROVIDER ENROLLMENT)
(615) 465-3334
Entity
Organization
Contact information
Practice address
5595 WOODBINE RD, PACE, FL 32571
(850) 981-7746
(850) 981-7743
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7255
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
—
208600000X
Surgery Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
04/25/2023
Last updated
04/25/2023
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