Organization
SANTA ROSA HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Santa Rosa Medical Group Cardiology
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR DR PROV ENROLLMENT & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
5992 BERRYHILL RD STE 201, MILTON, FL 32570-1014
(850) 981-3885
(850) 626-5474
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
208800000X
Urology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
FL
Enumeration date
09/09/2021
Last updated
03/16/2022
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