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General NPI Number Information
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NPI Number | 1083589691
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Entity Type | Organization
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Legal Business Name | VIDA FUNCTIONAL WELLNESS PLLC
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 3530 AUTUMN GLEN DR
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City | VALRICO
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State | FL
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Zip | 33596-8269
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Country | US
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Telephone | 813-586-0901
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Fax |
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Provider Business Mailing Address
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Address Line | 3530 AUTUMN GLEN DR
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City | VALRICO
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State | FL
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Zip | 33596-8269
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | FELIPE M SILVA
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Credential |
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Telephone | 813-586-0901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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