Organization
GULF COAST HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
REGIONAL CARDIAC AND VASCULAR ASSOCIATES, Gulf Coast 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
600 NOKOMIS AVE S STE 102, VENICE, FL 34285-3209
(941) 483-7651
(941) 483-7699
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
—
—
207UN0901X
Nuclear Cardiology Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277033432
—
FL
Enumeration date
07/16/2021
Last updated
03/15/2022
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