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: |