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General NPI Number Information
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NPI Number | 1669245064
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Entity Type | Organization
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Legal Business Name | VITAL HEALTH CONCIERGE LLC
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Dates
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Enumeration Date | 11/07/2023
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 325 S PARSONS AVE
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City | BRANDON
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State | FL
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Zip | 33511-5228
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Country | US
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Telephone | 813-397-6779
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Fax |
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Provider Business Mailing Address
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Address Line | 15418 FIRE ROCK PL
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City | RUSKIN
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State | FL
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Zip | 33573-0196
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Country | US
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Telephone | 813-545-0133
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/APRN
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Name | JENNA MADHAVAN
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Credential | APRN
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Telephone | 813-545-0133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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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 | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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