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General NPI Number Information
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NPI Number | 1982363743
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Entity Type | Organization
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Legal Business Name | BROOKSVILLE HMA PHYSICIAN MANAGEMENT LLC
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Dates
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Enumeration Date | 12/09/2021
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 11375 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-5409
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Country | US
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Telephone | 352-596-6632
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Fax | 352-999-9999
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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 | 877-892-9815
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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