Healthcare Provider Details

I. General information

NPI: 1588971881
Provider Name (Legal Business Name): MARICRUZ R BLOOMQUIST F.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 S EXPRESSWAY 77 SUITE 205
HARLINGEN TX
78550
US

IV. Provider business mailing address

5505 S EXPRESSWAY 77 SUITE 205
HARLINGEN TX
78550-3214
US

V. Phone/Fax

Practice location:
  • Phone: 956-421-2757
  • Fax: 956-421-2787
Mailing address:
  • Phone: 956-421-2757
  • Fax: 956-421-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number607383
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: