Provider Demographics
NPI:1508503756
Name:SHARON VITALE PA
Entity Type:Organization
Organization Name:SHARON VITALE PA
Other - Org Name:MOBILE WOUND AND SKIN PRACTITIONERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-427-5531
Mailing Address - Street 1:13515 155TH PL N
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-8576
Mailing Address - Country:US
Mailing Address - Phone:561-427-5531
Mailing Address - Fax:
Practice Address - Street 1:13515 155TH PL N
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33478-8576
Practice Address - Country:US
Practice Address - Phone:561-427-5531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114633300Medicaid