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General NPI Number Information
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NPI Number | 1801235445
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Entity Type | Organization
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Legal Business Name | SANTA ROSA HMA PHYSICIAN MANAGEMENT, LLC
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Dates
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Enumeration Date | 06/17/2013
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 1929 ORTEGA ST
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City | NAVARRE
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State | FL
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Zip | 32566-4111
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Country | US
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Telephone | 850-396-8048
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Fax | 850-936-8049
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Provider Business Mailing Address
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Address Line | 5811 PELICAN BAY BLVD 500
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City | NAPLES
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State | FL
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Zip | 34108-2704
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Country | US
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Telephone | 239-552-3514
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Fax | 239-592-0438
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Authorized Official
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Title or Position | SENIOR DIRECTOR PROVIDER ENROLLMENT
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Name | MS. 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 | 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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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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