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VIVANT MEDICAL GROUP LLC
NPI 1124652425
General Practice in Tampa, FL

Active since February 25, 2020
6214 MEMORIAL HWY STE B, TAMPA, FL 33615(800) 574-9491(800) 547-2802 Get Directions Write a Review

NPPES record last updated: July 6, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 6, 2021, Nov 3, 2020, Feb 25, 2020 (3 updates tracked since 2020).

About Vivant Medical Group Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VIVANT MEDICAL GROUP LLC (NPI 1124652425) is a healthcare organization registered as a general practice in Tampa, Florida and active in the NPI registry since February 2020. The organization maintains a secondary practice location in Sarasota and lists Daphnee Moise-johnson, President, as its authorized official.

NPPES Registry Identity

NPI1124652425
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameVIVANT MEDICAL GROUP LLC
Location Address6214 MEMORIAL HWY STE BTampa, FL 33615-4507
Mailing Address6214 Memorial Hwy Ste BTampa, FL 33615-4507 · (800) 574-9491 · Fax (800) 547-2802
Phone(800) 574-9491
Fax(800) 547-2802
Organization SubpartNo
Authorized OfficialDaphnee Moise-johnsonPresident · (800) 574-9491
Enumeration DateFebruary 25, 2020
Last NPPES UpdateJuly 6, 20213 updates tracked since enumeration
NPPES CertifiedJuly 6, 2021
✔ NPI 1124652425 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
6214 MEMORIAL HWY STE B, Tampa, FL 33615
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Secondary Practice Location 1

Location 115600 Hancock RdSarasota, FL 34240-6701 · Phone (813) 924-5210

Other Identifiers 1

Medicaid273932100FL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Vivant Medical Group LLC's NPI number?

The NPI number for Vivant Medical Group LLC is 1124652425. It was assigned to this organization in the NPPES registry on February 25, 2020.

Where is Vivant Medical Group LLC located?

Vivant Medical Group LLC is located at 6214 Memorial Hwy Ste B, Tampa, FL 33615. The listed phone number is (800) 574-9491.

What is Vivant Medical Group LLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

When was this NPI record last updated?

The NPPES record for Vivant Medical Group LLC was last updated on July 6, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.