Collier Boulevard Hma Physician Management LLC

NPI #1710555818 in Estero, Florida

Provider Information

NPI Number: 1710555818
Entity Type: Organization
Organization Name: Collier Boulevard Hma Physician Management LLC
Primary Specialty: General Practice
Enumeration Date: Jun 15, 2021
Last Updated: Mar 14, 2022

Practice Location

Address: 24231 WALDEN CENTER DR STE 160
City: Estero
State: Florida
ZIP Code: 34134-5011
Phone: (239) 348-4221

Authorized Official

Name: JENNIFER L JACKSON
Title: SR DIR PROV ENROLLMENT & ONBOARDING
Phone: (615) 465-3334

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nurse Practitioner	363L00000X
General Practice	208D00000X	Primary

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