MEDICARE: DOUBLE G VITAL SERVICES LLC

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	372600000X	Adult Companion
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1922805746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUBLE G VITAL SERVICES LLC

Provider Business Mailing Address
First Line	:	3018 N US HIGHWAY 301 STE 200
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-2271
Country	:	US
Telephone Number	:	813-679-5413
Fax Number	:

Provider Business Practice Location Address
First Line	:	3018 N US HIGHWAY 301 STE 200
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-2271
Country	:	US
Telephone Number	:	813-679-5413
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF NURSING
Name	:	PAULETTE VITAL-HERNE
Credential	:	APRN
Telephone Number	:	813-679-5413

Provider Enumeration Date	:	02/28/2025
Last Update Date	:	02/28/2025

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