Organization
BROOKSVILLE HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Brooksville HMA Physician Management 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
11175 COUNTY LINE RD, SPRING HILL, FL 34609-5615
(352) 686-8888
(352) 684-6888
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
—
—
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002631007
—
FL
Enumeration date
06/07/2021
Last updated
03/09/2022
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