Organization
BLOOM INTEGRATIVE WELLNESS CENTER OF SOUTH LAKE, LLC
Active
Organization
BLOOM INTEGRATIVE WELLNESS CENTER OF SOUTH LAKE, LLC
Active
Other names
Bloom Integrative Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY REYNOLDS WHNP (CEO)
(931) 980-1911
Entity
Organization
Contact information
Practice address
14114 DALLAS PKWY STE 310, DALLAS, TX 75254-1315
(844) 864-8928
Mailing address
539 W COMMERCE ST # 4488, DALLAS, TX 75208-1953
(844) 864-8928
Taxonomy
Speciality
Code
Description
License number
State
261QA0005X
Ambulatory Family Planning Facility
—
—
363LW0102X
Women's Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/14/2022
Last updated
01/27/2026
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