Santina Bloom

Individual provider Active NPI Licensed Practical Nurse · Bayport, NY

NPI 1861097271 · NPPES record last updated Dec 2, 2020

Key facts

NPI
1861097271
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
324150-01 (NY)
Practice address
415 Terrace Rd
Bayport, NY 11705-1526
Phone
(631) 525-3234
NPI assigned
Dec 2, 2020
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
324150-01NYMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 324150-01 NY Yes

Addresses

Primary practice location

415 Terrace Rd
Bayport, NY 11705-1526

Mailing address

415 Terrace Rd
Bayport, NY 11705-1526
Phone (631) 525-3234

Other providers in Bayport, NY

All providers in Bayport, NY · Licensed Practical Nurse in New York

Sources for this page

Verify at the official NPI Registry.