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NPI Code Detail

MEDICARE: VITALIFE MED LLC

MEDICARE: VITALIFE MED 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
1363L00000XNurse Practitioner
2261Q00000XClinic/Center
3363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1730017674
Entity Type Code : Organization
Provider Name (Legal Business Name) : VITALIFE MED LLC
Provider Business Mailing Address
First Line : 2540 WINKLER AVE STE 1
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-9338
Country : US
Telephone Number : 239-347-0810
Fax Number : 754-229-5558
Provider Business Practice Location Address
First Line : 2540 WINKLER AVE STE 1
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-9338
Country : US
Telephone Number : 239-347-0810
Fax Number : 754-229-5558
Authorized Official
Title or Position : PRESIDENT
Name : LIANET E COELLO BLANCO
Credential : APRN
Telephone Number : 239-347-0810
Provider Enumeration Date : 05/11/2026
Last Update Date : 06/03/2026

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Directions to “VITALIFE MED LLC ” Practice Location

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