Provider Demographics
NPI:1508524521
Name:BLOSSOM, SHEILA MICHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:MICHELLE
Last Name:BLOSSOM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 HARLESTON GREEN DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-7018
Mailing Address - Country:US
Mailing Address - Phone:843-742-2893
Mailing Address - Fax:
Practice Address - Street 1:2607 HARLESTON GREEN DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-7018
Practice Address - Country:US
Practice Address - Phone:843-742-2893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25635363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care