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General NPI Number Information
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NPI Number | 1417669961
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Entity Type | Organization
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Legal Business Name | VITAL HEALTH 2022 LLC
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Dates
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Enumeration Date | 12/15/2022
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 3120 SW 27TH AVE STE 300
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City | OCALA
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State | FL
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Zip | 34471-8984
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Country | US
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Telephone | 352-895-5200
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Fax | 855-552-3776
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Provider Business Mailing Address
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Address Line | 3120 SW 27TH AVE STE 300
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City | OCALA
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State | FL
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Zip | 34471-8984
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Country | US
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Telephone | 352-895-5200
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Fax | 855-552-3776
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Authorized Official
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Title or Position | OWNER
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Name | ERUM JIVA
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Credential | DNP
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Telephone | 352-895-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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