Organization
PUNTA GORDA HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Bayfront Health Medical Group Psychiatry, Punta Gorda 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
713 E MARION AVE STE 121, PUNTA GORDA, FL 33950-3862
(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
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278522614
—
FL
Enumeration date
06/24/2021
Last updated
03/18/2022
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