Organization
GULF COAST HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
GULF COAST MEDICAL GROUP - CARDIOTHORACIC SURGERY ASSOCIATES, 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
600 NOKOMIS AVE S STE 207, VENICE, FL 34285-3209
(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
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277033442
—
FL
Enumeration date
07/15/2021
Last updated
03/15/2022
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