Healthcare Provider Details

I. General information

NPI: 1225610967
Provider Name (Legal Business Name): VITAL EAGLES HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 02/16/2024
Certification Date: 02/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13021 W LINEBAUGH AVE STE 102
TAMPA FL
33626-4509
US

IV. Provider business mailing address

13021 W LINEBAUGH AVE STE 102
TAMPA FL
33626-4509
US

V. Phone/Fax

Practice location:
  • Phone: 813-709-8567
  • Fax: 215-642-8552
Mailing address:
  • Phone: 813-709-8567
  • Fax: 215-642-8552

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 Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name: ARLENIA PAULINO
Title or Position: OWNER/PRESIDENT
Credential: AUTHORIZED SIGNER
Phone: 215-205-2229