Provider Demographics
NPI:1578117594
Name:BLOOMFIELD, BROOKE STACIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:STACIE
Last Name:BLOOMFIELD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 UNIONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SEBEWAING
Mailing Address - State:MI
Mailing Address - Zip Code:48759-1631
Mailing Address - Country:US
Mailing Address - Phone:989-883-9088
Mailing Address - Fax:
Practice Address - Street 1:616 UNIONVILLE RD
Practice Address - Street 2:
Practice Address - City:SEBEWAING
Practice Address - State:MI
Practice Address - Zip Code:48759-1631
Practice Address - Country:US
Practice Address - Phone:989-883-9088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FM4704235365363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily