=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265398291
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITALITY VIRTUAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2026
-----------------------------------------------------
Last Update Date | 01/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17635 CORTES CREEK BLVD
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34610-0200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-599-0263
-----------------------------------------------------
Fax | 888-814-8630
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17635 CORTES CREEK BLVD
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34610-0200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-599-0263
-----------------------------------------------------
Fax | 888-814-8630
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING SUPERVISOR
-----------------------------------------------------
Name | HEATHER INGLE
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 409-599-0263
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------