Organization
BROOKSVILLE HMA PHYSICIAN MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SENIOR DIRECTOR PROVIDER ENROLLMENT)
(615) 465-3334
Entity
Organization
Contact information
Practice address
6201 N SUNCOAST BLVD, CRYSTAL RIVER, FL 34428-6712
(352) 795-6560
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
06/15/2022
Last updated
08/11/2022
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