Provider Demographics
NPI:1669137980
Name:VIVELO, JOSEPHINE
Entity type:Individual
Prefix:MS
First Name:JOSEPHINE
Middle Name:
Last Name:VIVELO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12464 FAIRWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-2608
Mailing Address - Country:US
Mailing Address - Phone:352-442-4161
Mailing Address - Fax:
Practice Address - Street 1:12464 FAIRWAY AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-2608
Practice Address - Country:US
Practice Address - Phone:352-442-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide