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Organization
VITALIFE MED LLC
Active
Organization
VITALIFE MED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIANET E COELLO BLANCO APRN (PRESIDENT)
(239) 347-0810
Entity
Organization
Contact information
Practice address
2540 WINKLER AVE STE 1, FORT MYERS, FL 33901-9338
(239) 347-0810
(754) 229-5558
Mailing address
2540 WINKLER AVE STE 1, FORT MYERS, FL 33901-9338
(239) 347-0810
(754) 229-5558
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/11/2026
Last updated
06/03/2026
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