Organization
PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Comprehensive Women's Care, Port Charlotte HMA Physician Management LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR DR PROV ENROLLMENT & ONLOADING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
713 E MARION AVE STE 139, PUNTA GORDA, FL 33950-3863
(941) 833-1760
(941) 205-3374
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
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
FL
Enumeration date
06/18/2021
Last updated
03/18/2022
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