Healthcare Provider Details

I. General information

NPI: 1104512979
Provider Name (Legal Business Name): VIRTU30 TELEHEALTH SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 16TH ST NE
NAPLES FL
34120-3447
US

IV. Provider business mailing address

1540 16TH ST NE
NAPLES FL
34120-3447
US

V. Phone/Fax

Practice location:
  • Phone: 877-298-2076
  • Fax:
Mailing address:
  • Phone: 239-877-2982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIN CHRISTINE CARR
Title or Position: OWNER
Credential: APRN
Phone: 317-697-9296