Provider Demographics
NPI:1902226566
Name:BLOOMBERG, MAYA CHELSEA SMITH (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MAYA
Middle Name:CHELSEA SMITH
Last Name:BLOOMBERG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:CHELSEA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1475 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1002
Mailing Address - Country:US
Mailing Address - Phone:305-243-6626
Mailing Address - Fax:305-243-0842
Practice Address - Street 1:1475 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1003
Practice Address - Country:US
Practice Address - Phone:305-689-5366
Practice Address - Fax:305-243-0842
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9326294163W00000X
FLARNP9326294363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse