Provider Demographics
NPI:1164202495
Name:VITIELLO, VIRGINIA MARIE (MSN, AGNP-C, EMT-B)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MARIE
Last Name:VITIELLO
Suffix:
Gender:F
Credentials:MSN, AGNP-C, EMT-B
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-952-2111
Mailing Address - Fax:423-282-1657
Practice Address - Street 1:2050 MEADOWVIEW PKWY
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7475
Practice Address - Country:US
Practice Address - Phone:423-230-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN38125363LA2200X
VA0024188620363LA2200X
NY311555363LG0600X, 363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care