Healthcare Provider Details

I. General information

NPI: 1407597230
Provider Name (Legal Business Name): VITAM FLORIDA HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 NW UNIVERSITY BLVD STE 102
PORT SAINT LUCIE FL
34986-2280
US

IV. Provider business mailing address

540 NW UNIVERSITY BLVD STE 102
PORT SAINT LUCIE FL
34986-2280
US

V. Phone/Fax

Practice location:
  • Phone: 772-310-1567
  • Fax: 772-673-3866
Mailing address:
  • Phone: 772-310-1567
  • Fax: 772-673-3866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KANOULD DOLCINE
Title or Position: MD/OWNER
Credential:
Phone: 754-207-1484