Organization
COLLIER BOULEVARD HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Physicians Regional Medical Group-Collier, Collier Boulevard 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
1839 SAN MARCO RD, MARCO ISLAND, FL 34145-6722
(239) 394-1670
(239) 394-1677
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
208800000X
Urology Physician
—
—
363A00000X
Physician Assistant
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001609604
—
FL
Enumeration date
06/15/2021
Last updated
03/14/2022
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