Individual
MRS. TRACY ROY BLOOM II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1705 GEORGIA ST, NAPA, CA 94559-1621
(707) 738-3637
Mailing address
1705 GEORGIA ST, NAPA, CA 94559-1621
(707) 265-6852
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
616687
CA
363LA2100X
Acute Care Nurse Practitioner
Primary
14057
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA131881
MEDICARE PTAN
CA
Enumeration date
10/24/2006
Last updated
10/15/2021
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