Provider Type Icon

COLLIER BOULEVARD HMA PHYSICIAN MANAGEMENT LLC NPI 1710555818


NPI Information

NPI: 1710555818
Provider Name: COLLIER BOULEVARD HMA PHYSICIAN MANAGEMENT LLC

Doing Business As: COLLIER BOULEVARD HMA PHYSICIAN MANAGEMENT LLC

Classification: General Practice - 208D00000X
Entity Type: Organization
Address:
24231 WALDEN CENTER DR STE 160
ESTERO, FL
ZIP 34134
Phone: (239) 348-4221
Get Directions

COLLIER BOULEVARD HMA PHYSICIAN MANAGEMENT LLC is a general practice in Estero, FL. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee COLLIER BOULEVARD HMA PHYSICIAN MANAGEMENT LLC NPI is 1710555818. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Collier Boulevard Hma Physician Management Llc.

The provider's business location address is:

24231 WALDEN CENTER DR STE 160
ESTERO, FL
ZIP 34134-011
Phone: (239) 348-4221
Fax: (239) 348-4529

The provider's authorized official is Jennifer L Jackson .
The authorized official title is Sr Dir Prov Enrollment & Onboarding and has the following contact phone number (615) 465-3334.

The enumeration date for this NPI number is 6/15/2021 and was last updated on 3/14/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363L00000XNurse PractitionerNo
2208D00000XGeneral PracticeYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1001609630MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.