Organization
COLLIER BOULEVARD HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Collier Boulevard HMA Physician Management LLC, Physicians Regional Medical Group-Collier
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 303, NAPLES, FL 34114-3626
(239) 348-4400
(239) 348-4197
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001609616
—
FL
Enumeration date
07/09/2021
Last updated
03/09/2022
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