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General NPI Number Information
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NPI Number | 1275497869
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Entity Type | Organization
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Legal Business Name | VITA EDGE CARE LLC
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 2808 BLUEJACK RD
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City | MCKINNEY
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State | TX
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Zip | 75071-3638
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Country | US
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Telephone | 775-287-6993
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Fax |
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Provider Business Mailing Address
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Address Line | 2808 BLUEJACK RD
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City | MCKINNEY
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State | TX
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Zip | 75071-3638
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Country | US
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Telephone | 775-287-6993
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOAN ANUKAM
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Credential | NURSE PRACTITIONER
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Telephone | 775-287-6993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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