MEDICARE: VITALITY VIRTUAL HEALTH LLC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1265398291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY VIRTUAL HEALTH LLC

Provider Business Mailing Address
First Line	:	17635 CORTES CREEK BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34610-0200
Country	:	US
Telephone Number	:	409-599-0263
Fax Number	:	888-814-8630

Provider Business Practice Location Address
First Line	:	17635 CORTES CREEK BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34610-0200
Country	:	US
Telephone Number	:	409-599-0263
Fax Number	:	888-814-8630

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	HEATHER INGLE
Credential	:	MA
Telephone Number	:	409-599-0263

Provider Enumeration Date	:	01/03/2026
Last Update Date	:	01/05/2026

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