Vivant Medical Group LLC
General Practice in Tampa, FL. Organization (NPI-2).
NPI number1124652425
StatusActive
Last updated in NPPESJul 6, 2021
Details
- NPI
- 1124652425
- Entity type
- Organization (NPI-2)
- Legal business name
- Vivant Medical Group LLC
- Organization subpart
- No
- Enumeration date
- Feb 25, 2020
- Certification date
- Jul 6, 2021
- Last updated
- Jul 6, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208D00000X | General Practice | – | – | Yes |
Practice location
6214 Memorial Hwy Ste BTampa, FL 33615-4507
Phone 800-574-9491 · Fax 800-547-2802
Mailing address
6214 Memorial Hwy Ste BTampa, FL 33615-4507
Phone 800-574-9491 · Fax 800-547-2802
Other practice locations
15600 Hancock Rd
Sarasota, FL 34240-6701
Sarasota, FL 34240-6701
Phone 813-924-5210
Authorized official
Daphnee Moise-Johnson
President
8005749491
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