MEDICARE: COLLIER BOULEVARD HMA PHYSICIAN MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	2082S0105X	Surgery of the Hand (Plastic Surgery) 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	:	1477124469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLIER BOULEVARD 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	:	8340 COLLIER BLVD STE 303
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34114-3626
Country	:	US
Telephone Number	:	239-348-4400
Fax Number	:	239-348-4197

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

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	03/09/2022

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Directions to “COLLIER BOULEVARD HMA PHYSICIAN MANAGEMENT LLC ” Practice Location

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