Healthcare Provider Details

I. General information

NPI: 1700697422
Provider Name (Legal Business Name): VITAL HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1479 SW GATLIN BLVD
PORT ST LUCIE FL
34953
US

IV. Provider business mailing address

1479 SW GATLIN BLVD
PORT ST LUCIE FL
34953
US

V. Phone/Fax

Practice location:
  • Phone: 561-880-9880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. NERLYN JESTINE
Title or Position: CEO
Credential: ARNP
Phone: 561-880-9880