Healthcare Provider Details

I. General information

NPI: 1588198451
Provider Name (Legal Business Name): EMILY VITALE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD DEPARTMENT OF PEDIATRICS
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

1600 SW ARCHER RD DEPARTMENT OF PEDIATRICS PO BOX 100296
GAINESVILLE FL
32610-3003
US

V. Phone/Fax

Practice location:
  • Phone: 239-464-7685
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number9389333
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: