Healthcare Provider Details

I. General information

NPI: 1124937974
Provider Name (Legal Business Name): AEGIS BLOOM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 CRESCENT CIR SW
FORT WALTON BEACH FL
32548-5325
US

IV. Provider business mailing address

33 CRESCENT CIR SW
FORT WALTON BEACH FL
32548-5325
US

V. Phone/Fax

Practice location:
  • Phone: 850-374-0417
  • Fax:
Mailing address:
  • Phone: 850-374-0417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMY CLAGGETT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 850-374-0417