Healthcare Provider Details

I. General information

NPI: 1215778683
Provider Name (Legal Business Name): VITA RN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2024
Last Update Date: 06/01/2024
Certification Date: 06/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13205 SW 137TH AVE STE 204
MIAMI FL
33186-5334
US

IV. Provider business mailing address

13205 SW 137TH AVE STE 204
MIAMI FL
33186-5334
US

V. Phone/Fax

Practice location:
  • Phone: 786-548-9787
  • Fax: 305-735-3599
Mailing address:
  • Phone: 786-548-9787
  • Fax: 305-735-3599

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: JOCELYN LUQUEZ
Title or Position: OWNER
Credential: APRN FNP-C
Phone: 786-548-9787