MEDICARE: COLLIER HMA PHYSICIAN MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RC0000X	Cardiovascular Disease Physician
2	363L00000X	Nurse Practitioner
3	363LF0000X	Family Nurse Practitioner
4	207V00000X	Obstetrics & Gynecology Physician
5	207X00000X	Orthopaedic Surgery Physician
6	363LP2300X	Primary Care Nurse Practitioner
7	207Q00000X	Family Medicine Physician
8	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154066462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLIER HMA PHYSICIAN MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	PO BOX 689022
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-9022
Country	:	US
Telephone Number	:	615-465-7211
Fax Number	:	615-628-6877

Provider Business Practice Location Address
First Line	:	8831 FOUNDERS SQUARE DR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120-0733
Country	:	US
Telephone Number	:	239-348-4221
Fax Number	:

Authorized Official
Title or Position	:	SR DIR PROV ENROLLMENT & ONBOARDING
Name	:	JENNIFER L JACKSON
Credential	:
Telephone Number	:	615-465-3334

Provider Enumeration Date	:	05/02/2022
Last Update Date	:	05/02/2022

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Directions to “COLLIER HMA PHYSICIAN MANAGEMENT LLC ” Practice Location

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