Organization
GULF COAST HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Gulf Coast HMA Physician Management LLC, Restore Medical Partners 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
333 TAMIAMI TRL S STE 183, VENICE, FL 34285-2426
(941) 375-3006
(941) 218-4825
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277033413
—
FL
Enumeration date
07/14/2021
Last updated
03/15/2022
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