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NPI Code Detail

MEDICARE: VIRGINIA MARIE VITIELLO MSN, AGNP-C, EMT-B

MEDICARE: VIRGINIA MARIE VITIELLO MSN, AGNP-C, EMT-B
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
1363LA2200XAdult Health Nurse Practitioner38125TN
2363LP2300XPrimary Care Nurse Practitioner311555NY
3363LA2200XAdult Health Nurse Practitioner0024188620VA
4363LA2200XAdult Health Nurse Practitioner311555NY
5363LG0600XGerontology Nurse Practitioner311555NY

General Provider Information

NPI Number : 1164202495
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIRGINIA MARIE VITIELLO MSN, AGNP-C, EMT-B
Provider Business Mailing Address
First Line : 1021 W OAKLAND AVE STE 310
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-2192
Country : US
Telephone Number : 423-952-2111
Fax Number :
Provider Business Practice Location Address
First Line : 2050 MEADOWVIEW PKWY
Second Line :
City : KINGSPORT
State : TN
Zip : 37660-7475
Country : US
Telephone Number : 423-230-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2023
Last Update Date : 12/12/2025

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