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General NPI Number Information
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NPI Number | 1386590800
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Entity Type | Organization
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Legal Business Name | BLOOM MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 03/06/2026
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 7932 W SAND LAKE RD STE 106
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City | ORLANDO
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State | FL
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Zip | 32819-7299
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Country | US
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Telephone | 407-465-1995
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Fax |
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Provider Business Mailing Address
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Address Line | 7932 W SAND LAKE RD STE 106
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City | ORLANDO
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State | FL
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Zip | 32819-7299
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Country | US
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Telephone | 407-465-1995
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Fax |
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Authorized Official
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Title or Position | OWNER / MANAGER
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Name | HAROON NAWAZ
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Credential |
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Telephone | 407-734-3644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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