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
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
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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