MEDICARE: BLISSFUL INTENTIONS LLC

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1144079765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLISSFUL INTENTIONS LLC

Provider Business Mailing Address
First Line	:	1691 U.S. 9
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753
Country	:	US
Telephone Number	:	717-341-8790
Fax Number	:

Provider Business Practice Location Address
First Line	:	1691 U.S. 9
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753
Country	:	US
Telephone Number	:	717-341-8790
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KHADIJA FOFANA
Credential	:	APN
Telephone Number	:	717-341-8790

Provider Enumeration Date	:	05/15/2024
Last Update Date	:	06/04/2026

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Directions to “BLISSFUL INTENTIONS LLC ” Practice Location

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