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General NPI Number Information
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NPI Number | 1306418694
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Entity Type | Organization
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Legal Business Name | PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC
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Dates
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Enumeration Date | 07/15/2021
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 18659 TAMIAMI TRL
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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 | 941-423-5035
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Fax | 941-423-5034
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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 | DIR PROV ENROLLMENT & ONBOARDING
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Name | KRISTINA MUSIC
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Credential |
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Telephone | 778-929-8158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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