Provider Demographics
NPI:1376190785
Name:VITALE, MARCI J (DNP FNP-BC AGACNP-BC)
Entity Type:Individual
Prefix:DR
First Name:MARCI
Middle Name:J
Last Name:VITALE
Suffix:
Gender:F
Credentials:DNP FNP-BC AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 W MICHIGAN AVE STE 10B
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-2301
Mailing Address - Country:US
Mailing Address - Phone:850-686-3237
Mailing Address - Fax:
Practice Address - Street 1:945 W MICHIGAN AVE STE 10B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-2301
Practice Address - Country:US
Practice Address - Phone:888-850-3926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3-000409363L00000X
FLAPRN11003785363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner