Healthcare Provider Details

I. General information

NPI: 1235169079
Provider Name (Legal Business Name): ELIZABETH ANNE VITARBO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/24/2023
Certification Date: 06/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-1370
US

IV. Provider business mailing address

PO BOX 100265
GAINESVILLE FL
32610-0265
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-9000
  • Fax: 352-392-8413
Mailing address:
  • Phone: 352-273-9000
  • Fax: 352-392-8413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME93374
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: