Provider Demographics
NPI:1720464126
Name:VITA, ANNA O
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:O
Last Name:VITA
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 1:6100 STEVENSON DR UNIT 207
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2433
Mailing Address - Country:US
Mailing Address - Phone:407-970-0047
Mailing Address - Fax:
Practice Address - Street 1:6100 STEVENSON DR UNIT 207
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-2433
Practice Address - Country:US
Practice Address - Phone:407-970-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health