Organization
COLLIER BOULEVARD HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Physicians Regional Medical Group-Collier, Collier Boulevard 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
8340 COLLIER BLVD STE 203, NAPLES, FL 34114-3589
(239) 348-4396
(239) 354-6010
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001609620
—
FL
Enumeration date
06/14/2021
Last updated
03/09/2022
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