Healthcare Provider Details

I. General information

NPI: 1023880580
Provider Name (Legal Business Name): NURSING VITAL LIFE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 SW 97TH AVE STE C-105
MIAMI FL
33165-2677
US

IV. Provider business mailing address

18521 NW 30TH AVE
MIAMI GARDENS FL
33056-3003
US

V. Phone/Fax

Practice location:
  • Phone: 786-332-4330
  • Fax:
Mailing address:
  • Phone: 786-609-3902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LISANDRA DE LA HILDA GARCIA SERRANO
Title or Position: NP
Credential: NP
Phone: 786-609-3902