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General NPI Number Information
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NPI Number | 1932098985
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Entity Type | Organization
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Legal Business Name | VITAL HEALTH OF FLORIDA LLC
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 10250 NORMANDY BLVD UNIT 802
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City | JACKSONVILLE
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State | FL
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Zip | 32221-8064
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Country | US
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Telephone | 904-379-7155
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Fax | 904-379-7165
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Provider Business Mailing Address
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Address Line | 705 WELLS RD STE 300
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City | ORANGE PARK
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State | FL
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Zip | 32073-2982
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Country | US
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Telephone | 904-282-6331
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Fax | 904-866-4818
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Authorized Official
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Title or Position | CEO
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Name | ANDREW CHRISTMAN
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Credential |
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Telephone | 904-282-6331
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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