Provider Demographics
NPI: | 1124819172 |
---|---|
Name: | COLLIER HMA PHYSICIAN MANAGEMENT LLC |
Entity type: | Organization |
Organization Name: | COLLIER HMA PHYSICIAN MANAGEMENT LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR, PROVIDER ENROLLMENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KRISTINA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MUSIC |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 877-892-9815 |
Mailing Address - Street 1: | PO BOX 689022 |
Mailing Address - Street 2: | |
Mailing Address - City: | FRANKLIN |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37068-9022 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-465-7211 |
Mailing Address - Fax: | 615-628-6877 |
Practice Address - Street 1: | 6376 PINE RIDGE RD UNIT 420 |
Practice Address - Street 2: | |
Practice Address - City: | NAPLES |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34119-3908 |
Practice Address - Country: | US |
Practice Address - Phone: | 239-348-4279 |
Practice Address - Fax: | 239-348-4438 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2025-05-16 |
Last Update Date: | 2025-05-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |