Organization
GULF COAST HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
THE HEART AND VASCULAR CENTER OF VENICE, 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
901 VENETIA BAY BLVD STE 300, VENICE, FL 34285-8044
(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
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277033447
—
FL
Enumeration date
06/21/2021
Last updated
03/15/2022
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