| Doctor Name: | MS. CRYSTAL D BLOOM |
| NPI Number: | 1174898902 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | RN9324837 |
| Business Practice Address: | 3292 County Road 220 Middleburg, FL - 320684357 |
| Business Phone Number: | 9042915561 |
| Business Fax Number: | 9042915575 |
| Mailing Address: | 1726 Kingsley Ave, Suite 2 ORANGE PARK |
| State: | FL |
| Postal Code: | 320734463 |
| Phone Number: | 9042785644 |
| Fax Number: | 9042785659 |
| NPI Enumeration Date: | 03/13/2012 |
| NPI Last Update Date: | 03/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0808X |
| License Number: | RN9324837 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |