| NPI | 1407626989 |
|---|---|
| Other Name | ADULT VITALITY HEALTHCARELLC |
| Entity Type | Organization |
| Authorized Contact | RUTH GOBOURNE Mgr 863-608-0559 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2024-01-04 |
| Last Update Date | 2024-01-04 |