Organization
COLLIER HMA PHYSICIAN MANAGMENT, INC.
Active
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
1845 SAN MARCO RD, UNIT 203, MARCO ISLAND, FL 34145-6722
(239) 348-4400
Mailing address
PO BOX 277575, ATLANTA, GA 30384-7575
(866) 391-6826
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
275883103
—
FL
Enumeration date
12/28/2006
Last updated
03/09/2022
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