MEDICARE: DV3 HEALTH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144941816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DV3 HEALTH, INC.

Provider Business Mailing Address
First Line	:	11740 SW 80TH ST STE 102
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4822
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 NORTON DR STE 102B
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5965
Country	:	US
Telephone Number	:	850-202-1005
Fax Number	:	850-220-4559

Authorized Official
Title or Position	:	OWNER & DIRECTOR
Name	:	TINA VIDAL-DUART
Credential	:
Telephone Number	:	850-738-7977

Provider Enumeration Date	:	09/09/2022
Last Update Date	:	09/06/2023

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