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NPI Code Detail

MEDICARE: JESSICA MARYANNE BLOOM PA

MEDICARE: JESSICA MARYANNE BLOOM PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant3674TN

General Provider Information

NPI Number : 1073963328
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA MARYANNE BLOOM PA
Provider Business Mailing Address
First Line : 1718 PATTERSON ST
Second Line :
City : NASHVILLE
State : TN
Zip : 37203-2926
Country : US
Telephone Number : 615-379-3553
Fax Number : 615-346-8479
Provider Business Practice Location Address
First Line : 1718 PATTERSON ST
Second Line :
City : NASHVILLE
State : TN
Zip : 37203-2926
Country : US
Telephone Number : 615-379-3553
Fax Number : 615-346-8479
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2016
Last Update Date : 04/14/2026

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Directions to “ JESSICA MARYANNE BLOOM PA” Practice Location

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