Healthcare Provider Details

I. General information

NPI: 1346130127
Provider Name (Legal Business Name): TERRA KRISTINE VITIELLO FDNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15023 S EAGLE CREST DR
DRAPER UT
84020-5720
US

IV. Provider business mailing address

15023 S EAGLE CREST DR
DRAPER UT
84020-5720
US

V. Phone/Fax

Practice location:
  • Phone: 619-876-1276
  • Fax:
Mailing address:
  • Phone: 619-876-1276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: