Provider Demographics
NPI:1083459879
Name:VIBRANT LIVING
Entity type:Organization
Organization Name:VIBRANT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:H
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:339-237-1510
Mailing Address - Street 1:39 QUARRY LN
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-4520
Mailing Address - Country:US
Mailing Address - Phone:339-237-1510
Mailing Address - Fax:
Practice Address - Street 1:28 NEW DRIFTWAY
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4532
Practice Address - Country:US
Practice Address - Phone:781-545-0020
Practice Address - Fax:781-544-7312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty