Provider Demographics
NPI:1588971881
Name:BLOOMQUIST, MARICRUZ R (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARICRUZ
Middle Name:R
Last Name:BLOOMQUIST
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5505 S EXPRESSWAY 77
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3214
Mailing Address - Country:US
Mailing Address - Phone:956-421-2757
Mailing Address - Fax:956-421-2787
Practice Address - Street 1:5505 S EXPRESSWAY 77
Practice Address - Street 2:SUITE 205
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550
Practice Address - Country:US
Practice Address - Phone:956-421-2757
Practice Address - Fax:956-421-2787
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX607383364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX346845601Medicaid
TX8FF769OtherBLUECROSS BLUESHIELD