MEDICARE: VIDA FUNCTIONAL WELLNESS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1083589691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIDA FUNCTIONAL WELLNESS PLLC

Provider Business Mailing Address
First Line	:	3530 AUTUMN GLEN DR
Second Line	:
City	:	VALRICO
State	:	FL
Zip	:	33596-8269
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 AUTUMN GLEN DR
Second Line	:
City	:	VALRICO
State	:	FL
Zip	:	33596-8269
Country	:	US
Telephone Number	:	813-586-0901
Fax Number	:

Authorized Official
Title or Position	:	CO-FOUNDER
Name	:	FELIPE M SILVA
Credential	:
Telephone Number	:	813-586-0901

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	10/06/2025

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