Individual
JORDAN VITALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8000 SR 64 E, BRADENTON, FL 34212
(941) 792-1404
Mailing address
8000 SR 64 E, BRADENTON, FL 34212
(941) 792-1404
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9118910
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/07/2022
Last updated
03/14/2025
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