Provider Demographics
NPI:1801391388
Name:VITALIS, ANN-MARIE
Entity Type:Individual
Prefix:MRS
First Name:ANN-MARIE
Middle Name:
Last Name:VITALIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANN-MARIE
Other - Middle Name:
Other - Last Name:VITALIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:800 S NOVA RD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9048
Mailing Address - Country:US
Mailing Address - Phone:386-228-9700
Mailing Address - Fax:386-228-9701
Practice Address - Street 1:800 S NOVA RD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-228-9700
Practice Address - Fax:386-228-9701
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF03180313363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty