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 405, NAPLES, FL 34114-3626
(239) 354-6562
(239) 775-0759
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
—
—
207RG0100X
Gastroenterology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208600000X
Surgery Physician
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001609629
—
FL
Enumeration date
07/09/2021
Last updated
03/09/2022
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