Provider Demographics
NPI:1922805746
Name:DOUBLE G VITAL SERVICES LLC
Entity type:Organization
Organization Name:DOUBLE G VITAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VITAL-HERNE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:813-679-5413
Mailing Address - Street 1:3018 N US HIGHWAY 301 STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-2271
Mailing Address - Country:US
Mailing Address - Phone:813-679-5413
Mailing Address - Fax:
Practice Address - Street 1:3018 N US HIGHWAY 301 STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-2271
Practice Address - Country:US
Practice Address - Phone:813-679-5413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty