Blooming Personal Development, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

BLOOMING PERSONAL DEVELOPMENT, LLC

Practice address

1730 Shadowood LN Ste 370
Jacksonville, FL 32207-1133

Phone

(904) 536-4318

NPI assigned

May 10, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jacqulene Trinette Tarver

Title

Owner/ Program Administrator

Phone

(904) 536-4318

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697414400000",
    "number": "1316637689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 SHADOWOOD LN STE 370",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322071133",
            "telephone_number": "904-536-4318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 SHADOWOOD LN STE 370",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322071133",
            "telephone_number": "904-536-4318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMING PERSONAL DEVELOPMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-10",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A",
        "authorized_official_last_name": "TARVER",
        "authorized_official_first_name": "JACQULENE",
        "authorized_official_middle_name": "TRINETTE",
        "authorized_official_title_or_position": "OWNER/ PROGRAM ADMINISTRATOR",
        "authorized_official_telephone_number": "904-536-4318"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katira Maelena Bloodsaw
• Kathaleen C Bloom, CNM
• Richard R Bloom, DC
• Serena Lurie Bloomfield, ED.D.
• Stephen Irwin Bloomfield, ED.D.
• Blooming Speech & Language Therapy, LLC
• Wendy Lynn Bloomquist, CRNA
• Blossom & Grow Pediatric Therapy Inc.
• Blossom Atrium LLC
• Blossom Forward LLC

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.