Healthcare Provider Details

I. General information

NPI: 1245144203
Provider Name (Legal Business Name): AMY M ROSENBLOOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6599 BLUE BAY CIR
LAKE WORTH FL
33467-7220
US

IV. Provider business mailing address

6599 BLUE BAY CIR
LAKE WORTH FL
33467-7220
US

V. Phone/Fax

Practice location:
  • Phone: 561-317-1337
  • Fax:
Mailing address:
  • Phone: 561-317-1337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: