| Collier Boulevard Hma Physician Management Llc | |
|
24231 Walden Center Dr Ste 160 Estero FL 34134-5011 | |
| (239) 348-4221 | |
| (239) 348-4529 |
| Full Name | Collier Boulevard Hma Physician Management Llc |
|---|---|
| Speciality | General Practice |
| Location | 24231 Walden Center Dr Ste 160, Estero, Florida |
| Authorized Official Name and Position | Jennifer L Jackson (SR DIR PROV ENROLLMENT & ONBOARDING) |
| Authorized Official Contact | 6154653334 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Collier Boulevard Hma Physician Management Llc Po Box 689022 Franklin TN 37068-9022 Ph: (615) 465-7211 | Collier Boulevard Hma Physician Management Llc 24231 Walden Center Dr Ste 160 Estero FL 34134-5011 Ph: (239) 348-4221 |
| NPI Number | 1710555818 |
|---|---|
| Provider Enumeration Date | 06/15/2021 |
| Last Update Date | 03/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710555818 | NPI | - | NPPES |
| 001609630 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
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