Organization
CRYSTAL RIVER HMA PHYSICIAN MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR DIR ONBOARDING & PROV ENROLLMENT)
(615) 465-3334
Entity
Organization
Contact information
Practice address
5915 W GULF TO LAKE HWY, CRYSTAL RIVER, FL 34429-7565
(352) 794-3872
(352) 794-3876
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
208D00000X
General Practice Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
02/16/2017
Last updated
03/14/2022
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