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
8431 POINTE LOOP DR STE 2, VENICE, FL 34293-2232
(941) 207-5330
(941) 207-5346
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
FL
Enumeration date
08/25/2021
Last updated
03/18/2022
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