Tina Marie Bloomer, MS, RD/LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

L002206 Issued in NC

Practice address

512 Brickhaven Dr
Raleigh, NC 27606-1492

Phone

(704) 607-4924

Fax

(704) 469-0879

NPI assigned

Nov 22, 2013

Last updated

Apr 15, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Tina Marie Mendieta Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1385078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1669802930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7035 WALNUT BRANCH LANE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282778939",
            "telephone_number": "704-607-4924",
            "fax_number": "704-469-0879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 BRICKHAVEN DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276061492",
            "telephone_number": "704-607-4924",
            "fax_number": "704-469-0879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOMER",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "MS, RD/LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-22",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "L002206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TINA",
            "last_name": "MENDIETA",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bloodline Mobile Phlebotomy Service
• Bloom Holistic Bodywork
• Bloom Joy LLC
• Allan Albert Bloom, PH.D
• Haley Elizabeth Bloom
• Blooming Minds, PLLC
• Bloomsbury Therapy
• Bloomwell Behavioral Health Inc.
• Blossom & Bloom Wellness Services, PLLC
• Shon Blotzer

• Registered Dietitian in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Registered Dietitian in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; 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.