Healthcare Provider Details

I. General information

NPI: 1992460117
Provider Name (Legal Business Name): MICHAEL BRIEN BLOODWORTH JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 6TH ST S
SAINT PETERSBURG FL
33701-4891
US

IV. Provider business mailing address

701 6TH ST S
SAINT PETERSBURG FL
33701-4891
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-2335
  • Fax:
Mailing address:
  • Phone: 321-841-2335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN152813
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11036844
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: