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General NPI Number Information
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NPI Number | 1013685973
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Entity Type | Organization
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Legal Business Name | GULF COAST HMA PHYSICIAN MANAGEMENT LLC
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 18659 TAMIAMI TRL STE A
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City | NORTH PORT
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State | FL
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Zip | 34287-7388
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Country | US
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Telephone | 941-429-3416
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Fax | 941-429-3430
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Provider Business Mailing Address
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Address Line | PO BOX 689022
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City | FRANKLIN
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State | TN
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Zip | 37068-9022
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Country | US
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Telephone | 615-465-7211
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Fax | 615-628-6877
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Authorized Official
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Title or Position | SR DR PROV ENROLLMENT & ONBOARDING
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Name | JENNIFER L JACKSON
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Credential |
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Telephone | 615-465-3334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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