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Organization
IN BLOOM BIRTH AND WELLNESS PLLC
Active
Organization
IN BLOOM BIRTH AND WELLNESS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA GAIL LEGAULT CNM, APRN (OWNER/PROVIDER)
(321) 312-1494
Entity
Organization
Contact information
Practice address
1370 SARNO RD STE D, MELBOURNE, FL 32935-5230
(321) 354-6911
(321) 617-5786
Mailing address
2032 SIROCO LN, MELBOURNE, FL 32934-7600
(321) 312-1494
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
—
NULL
363LP2300X
Primary Care Nurse Practitioner
—
—
363LW0102X
Women's Health Nurse Practitioner
—
NULL
363LW0102X
Women's Health Nurse Practitioner
—
—
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
—
NULL
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1740774470
PROVIDER NPI
—
01
—
APRN11000324
APRN LICENSE #
FL
Enumeration date
06/17/2022
Last updated
04/11/2024
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