Organization
GULF COAST HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Regional Cardiac & Vascular 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 203, VENICE, FL 34285-3209
(941) 483-7651
(941) 483-7699
Mailing address
600 NOKOMIS AVE S STE 203, VENICE, FL 34285-3209
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207UN0901X
Nuclear Cardiology Physician
—
—
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277033442
—
FL
Enumeration date
07/14/2021
Last updated
03/15/2022
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