Provider Demographics
NPI:1770004723
Name:VITA FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:VITA FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:I
Authorized Official - Last Name:STURCKEN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:910-677-9488
Mailing Address - Street 1:609 EXECUTIVE PL STE B
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5713
Mailing Address - Country:US
Mailing Address - Phone:910-677-9488
Mailing Address - Fax:866-694-9185
Practice Address - Street 1:609 EXECUTIVE PL STE B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5713
Practice Address - Country:US
Practice Address - Phone:910-489-3185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care