Healthcare Provider Details

I. General information

NPI: 1265398291
Provider Name (Legal Business Name): VITALITY VIRTUAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17635 CORTES CREEK BLVD
SPRING HILL FL
34610-0200
US

IV. Provider business mailing address

17635 CORTES CREEK BLVD
SPRING HILL FL
34610-0200
US

V. Phone/Fax

Practice location:
  • Phone: 409-599-0263
  • Fax: 888-814-8630
Mailing address:
  • Phone: 409-599-0263
  • Fax: 888-814-8630

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: HEATHER INGLE
Title or Position: BILLING SUPERVISOR
Credential: MA
Phone: 409-599-0263