# ADULT VITALITY HEALTHCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ADULT VITALITY HEALTHCARELLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407626989
- **Authorized official:** RUTH GOBOURNE (MGR)
- **Authorized official phone:** (863) 608-0559

## Contact information

- **Practice address:** 7969 OAK RUN CIR, LAKELAND, FL 33809-7253
- **Practice address phone:** (863) 608-0559
- **Mailing address:** 2946 CREEKS CROSSING BLVD, LAKELAND, FL 33810-0216
- **Mailing address phone:** (863) 608-0559

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 01/04/2024
- **Last updated:** 01/04/2024