Individual
MS. CRYSTAL D BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3292 COUNTY ROAD 220, MIDDLEBURG, FL 32068-4357
(904) 291-5561
(904) 291-5575
Mailing address
1726 KINGSLEY AVE, SUITE 2, ORANGE PARK, FL 32073-4463
(904) 278-5644
(904) 278-5659
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN9324837
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9324837
—
FL
Enumeration date
03/13/2012
Last updated
03/13/2012
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