# IN BLOOM BIRTH AND WELLNESS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649901992
- **Authorized official:** LINDA GAIL LEGAULT CNM, APRN (OWNER/PROVIDER)
- **Authorized official phone:** (321) 312-1494

## Contact information

- **Practice address:** 1370 SARNO RD STE D, MELBOURNE, FL 32935-5230
- **Practice address phone:** (321) 354-6911
- **Practice address fax:** (321) 617-5786
- **Mailing address:** 2032 SIROCO LN, MELBOURNE, FL 32934-7600
- **Mailing address phone:** (321) 312-1494

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 363LX0001X | Obstetrics & Gynecology Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 06/17/2022
- **Last updated:** 04/11/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1740774470 | PROVIDER NPI | — |
| 01 | — | APRN11000324 | APRN LICENSE \# | FL |