Healthcare Provider Details

I. General information

NPI: 1902319783
Provider Name (Legal Business Name): NICHOLAS JAMES VIGORITO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29910 STATE ROAD 56
WESLEY CHAPEL FL
33543-8800
US

IV. Provider business mailing address

30700 TREMONT DR
WESLEY CHAPEL FL
33543-7854
US

V. Phone/Fax

Practice location:
  • Phone: 813-922-3300
  • Fax:
Mailing address:
  • Phone: 813-943-2314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberM2100192
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT3779
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: