Organization
PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Port Charlotte 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
2400 HARBOR BLVD STE 7, PORT CHARLOTTE, FL 33952-5038
(941) 766-5099
(941) 766-4884
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
—
—
2086S0129X
Vascular Surgery Physician
Primary
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
FL
Enumeration date
11/30/2021
Last updated
05/25/2022
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