Organization · NPI-2

Adult Vitality Healthcare LLC

Nurse Practitioner, Primary Care · Lakeland, FL

NPI number1407626989

StatusActive

Last updated in NPPESJan 4, 2024

Details

NPI: 1407626989
Entity type: Organization (NPI-2)
Legal business name: Adult Vitality Healthcare LLC
Organization subpart: No
Enumeration date: Jan 4, 2024
Certification date: Jan 4, 2024
Last updated: Jan 4, 2024

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
363LP2300X	Nurse Practitioner, Primary Care	–	–	Yes

Other names

Adult Vitality Healthcarellc (Other Name)

Practice location

7969 Oak Run Cir
Lakeland, FL 33809-7253

Phone 863-608-0559

Mailing address

2946 Creeks Crossing Blvd
Lakeland, FL 33810-0216

Phone 863-608-0559

Authorized official

Ruth Gobourne
Mgr
8636080559

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