Provider Demographics
NPI:1699351494
Name:BLOOMER, TRACEY ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:ANN
Last Name:BLOOMER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:UNION BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-3107
Mailing Address - Country:US
Mailing Address - Phone:848-218-2704
Mailing Address - Fax:732-291-5901
Practice Address - Street 1:521 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:UNION BEACH
Practice Address - State:NJ
Practice Address - Zip Code:07735-3107
Practice Address - Country:US
Practice Address - Phone:848-218-2704
Practice Address - Fax:732-291-5901
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP04651700164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse