| Santa Rosa Hma Physician Management Llc | |
|
5992 Berryhill Rd Ste 205 Milton FL 32570-1014 | |
| (850) 626-5324 | |
| (850) 626-5325 |
| Full Name | Santa Rosa Hma Physician Management Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 5992 Berryhill Rd Ste 205, Milton, 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 |
|---|---|
| Santa Rosa Hma Physician Management Llc Po Box 689022 Franklin TN 37068-9022 Ph: (615) 465-7211 | Santa Rosa Hma Physician Management Llc 5992 Berryhill Rd Ste 205 Milton FL 32570-1014 Ph: (850) 626-5324 |
| NPI Number | 1679140537 |
|---|---|
| Provider Enumeration Date | 06/09/2021 |
| Last Update Date | 03/16/2022 |
| Certification Date | 03/16/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679140537 | NPI | - | NPPES |
| 374819715 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
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