MEDICARE: ELIZABETH JAYNES VITULLI FNP-BC

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	1169481	TX

General Provider Information

NPI Number	:	1811725617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH JAYNES VITULLI FNP-BC

Provider Business Mailing Address
First Line	:	15 SMITH RD STE 3004
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79705-5461
Country	:	US
Telephone Number	:	281-734-1759
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 SMITH RD STE 3004
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79705-5461
Country	:	US
Telephone Number	:	432-699-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	12/15/2024

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