# VITA FAMILY MEDICINE AND MEDSPA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730532359
- **Authorized official:** DR. JENNIFER BOUDREAU M.D (OWNER/DOCTOR)
- **Authorized official phone:** (717) 805-8264

## Contact information

- **Practice address:** 540 FORT EVANS RD, SUITE 204, LEESBURG, VA 20176-3379
- **Practice address phone:** (703) 737-3500
- **Practice address fax:** (703) 737-3550
- **Mailing address:** 540 FORT EVANS RD, SUITE 204, LEESBURG, VA 20176-3379
- **Mailing address phone:** (703) 737-3500
- **Mailing address fax:** (703) 737-3550

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | VA | Yes |
| 261QP2300X | Primary Care Clinic/Center | 0101258315 | VA | — |

## Other

- **Enumeration date:** 07/19/2016
- **Last updated:** 10/13/2016