Healthcare Provider Details

I. General information

NPI: 1053241703
Provider Name (Legal Business Name): VITALCORE NP HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 S JOG RD STE 110
DELRAY BEACH FL
33446-2164
US

IV. Provider business mailing address

15300 S JOG RD STE 110
DELRAY BEACH FL
33446-2164
US

V. Phone/Fax

Practice location:
  • Phone: 786-514-2184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANA CRISTINA CLYMAN
Title or Position: MGR
Credential: APRN
Phone: 786-514-2184