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General NPI Number Information
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NPI Number | 1740949841
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Entity Type | Organization
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Legal Business Name | COLLIER HMA PHYSICIAN MANAGEMENT, LLC
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Dates
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Enumeration Date | 12/16/2021
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 1285 CREEKSIDE BLVD E
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City | NAPLES
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State | FL
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Zip | 34109-0590
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Country | US
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Telephone | 239-348-4221
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Fax | 239-529-1850
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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 |
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Authorized Official
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Title or Position | SR DIR ONBOARDING & PROV ENROLLMENT
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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