Healthcare Provider Details

I. General information

NPI: 1902723356
Provider Name (Legal Business Name): VITAL EDGE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 SANTAREM CIR
PUNTA GORDA FL
33983-4222
US

IV. Provider business mailing address

160 SANTAREM CIR
PUNTA GORDA FL
33983-4222
US

V. Phone/Fax

Practice location:
  • Phone: 941-451-7849
  • Fax: 941-259-0721
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JASON RITENOUR
Title or Position: MANAGING MEMBER
Credential: APRN
Phone: 941-451-7849