Bloom, Crystal D

Bloom, Crystal D is an individual health care provider with primary practice located at 3292 County Road 220 , Middleburg FL 32068-4357. She recently has only one registered license in Nursing Service Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Bloom, Crystal D can be contacted via phone (904) 291-5561.

Contact Information

Primary practice address
3292 County Road 220 Middleburg FL 32068-4357
Phone: (904) 291-5561
Fax: (904) 291-5575
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Psychiatric/Mental Health 163WP0808X RN9324837 Florida

Profile Details

NPI number 1174898902
LBN Legal business name Bloom, Crystal D
Credentials Registered Nurse (RN)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 13th, 2012
Last updated Mar 13th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174898902 NPPES
Florida MEDICAID 9324837

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