Healthcare Provider Details

I. General information

NPI: 1255250205
Provider Name (Legal Business Name): VIVABLUE MEDICAL & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N UNIVERSITY DR STE 2E
CORAL SPRINGS FL
33065-5055
US

IV. Provider business mailing address

6289 NW 62ND TER
PARKLAND FL
33067-1535
US

V. Phone/Fax

Practice location:
  • Phone: 754-264-3872
  • Fax:
Mailing address:
  • Phone: 754-264-3872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA MCMILLAN-ZITON
Title or Position: OWNER/MGR
Credential: DO
Phone: 754-264-3872