Bluebird Medical & Wellness Corp

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BLUEBIRD MEDICAL & WELLNESS CORP

Practice address

145 Hilden Rd Ste 102
Ponte Vedra, FL 32081-8401

Phone

(904) 600-4099

Fax

(904) 484-7919

NPI assigned

Sep 17, 2021

Organization subpart

No

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

Authorized official

Name

Anna Moyer, PHARM.D.

Title

President

Phone

(904) 600-4099

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1631836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632182400000",
    "number": "1992475289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 HILDEN RD STE 102",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320818401",
            "telephone_number": "904-600-4099",
            "fax_number": "904-484-7919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 HILDEN RD STE 102",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320818401",
            "telephone_number": "904-600-4099",
            "fax_number": "904-484-7919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEBIRD MEDICAL & WELLNESS CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-17",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A",
        "authorized_official_last_name": "MOYER",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-600-4099",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1835P2201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist, Ambulatory Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bella Cesca International, LLC
• Rebecca Bertone, APRN
• Alonzo Carlos Blackmon, D.D.S, M.S.
• Blue Water Dental of St. Johns
• Blue Water Health and Wellness LLC
• Bluebird Pediatrics
• Bluewater Wellness Center
• Jennifer Borgio, ATC
• William David Boyd, M.D.
• Melanie Loretta Bradley, DO

• Family Medicine Physician in Ponte Vedra, FL
• Providers in Ponte Vedra, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; 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.