=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598622383
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITALITY WELLNESS AND IV HYDRATION, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2026
-----------------------------------------------------
Last Update Date | 01/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 N FRANKLIN ST
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27025-1916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-247-0588
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 N FRANKLIN ST
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27025-1916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-247-0588
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/NURSE PRACTITIONER
-----------------------------------------------------
Name | MANDY LYNN TUTTLE
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 336-247-0588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------