Healthcare Provider Details

I. General information

NPI: 1477436657
Provider Name (Legal Business Name): ANA ELIZABETH VITACCO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD
DALLAS TX
75216-7167
US

IV. Provider business mailing address

3210 SOUTHSHORE CT
MIDLOTHIAN TX
76065-1393
US

V. Phone/Fax

Practice location:
  • Phone: 214-742-8387
  • Fax:
Mailing address:
  • Phone: 817-808-7434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number849234
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: