MEDICARE: VNA SPACE COAST, INC.

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	251E00000X	Home Health Agency	HHA299991471	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	107632	OTHER	FL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811994270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VNA SPACE COAST, INC.

Provider Business Mailing Address
First Line	:	958 20TH PL FL 2
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6420
Country	:	US
Telephone Number	:	772-567-5551
Fax Number	:	772-569-1444

Provider Business Practice Location Address
First Line	:	391 COMMERCE PKWY STE 240-260
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4209
Country	:	US
Telephone Number	:	772-567-5551
Fax Number	:	772-569-1444

Authorized Official
Title or Position	:	VP OF CLINICAL OPERATIONS
Name	:	JACQUELINE MARY KEVILLE
Credential	:
Telephone Number	:	772-538-2504

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	01/16/2026

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Directions to “VNA SPACE COAST, INC. ” Practice Location

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