Provider Demographics
NPI:1437607462
Name:BLOOMFIELD, THERESA ANN (RN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:BLOOMFIELD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HETRICK POINT RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4873
Mailing Address - Country:US
Mailing Address - Phone:732-988-6420
Mailing Address - Fax:732-998-6420
Practice Address - Street 1:2 HETRICK POINT RD
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4873
Practice Address - Country:US
Practice Address - Phone:732-988-6420
Practice Address - Fax:732-998-6420
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO08670600163W00000X, 163WA0400X, 163WG0000X, 163WH0200X, 163WM1400X, 163WN1003X, 163WP0807X, 163WP0808X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult