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Organization
ADULT VITALITY HEALTHCARE LLC
Active
Organization
ADULT VITALITY HEALTHCARE LLC
Active
Other names
ADULT VITALITY HEALTHCARELLC
Organization subpart
No
Provider details
NPI number
Authorized official
RUTH GOBOURNE (MGR)
(863) 608-0559
Entity
Organization
Contact information
Practice address
7969 OAK RUN CIR, LAKELAND, FL 33809-7253
(863) 608-0559
Mailing address
2946 CREEKS CROSSING BLVD, LAKELAND, FL 33810-0216
(863) 608-0559
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
NULL
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/04/2024
Last updated
01/04/2024
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