MEDICARE: NEXUS VITALITY CENTER 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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1538023163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXUS VITALITY CENTER PLLC

Provider Business Mailing Address
First Line	:	15657 N HAYDEN RD STE 1167
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-1945
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8327 IVY LEAF ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6834
Country	:	US
Telephone Number	:	702-945-8262
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAMMY NZIVO
Credential	:
Telephone Number	:	702-945-8262

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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