Organization
PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Port Charlotte 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
3508 TAMIAMI TRL, PORT CHARLOTTE, FL 33952-8160
(941) 883-3313
(941) 883-3320
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278507213
—
FL
Enumeration date
06/18/2021
Last updated
03/16/2022
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