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General NPI Number Information
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NPI Number | 1902723356
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Entity Type | Organization
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Legal Business Name | VITAL EDGE WELLNESS, LLC
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Dates
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Enumeration Date | 07/06/2026
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Last Update Date | 07/06/2026
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Provider Practice Location Address
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Address Line | 2079 PENNSYLVANIA AVE
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City | ENGLEWOOD
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State | FL
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Zip | 34224-5644
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Country | US
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Telephone | 919-451-7849
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Fax |
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Provider Business Mailing Address
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Address Line | 5342 CLARK RD # 1037
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City | SARASOTA
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State | FL
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Zip | 34233-3227
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JASON RITENOUR
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Credential | APRN
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Telephone | 941-451-7849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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