Provider Demographics
NPI:1528302742
Name:VITALE-AMOS, GINA MARIE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:VITALE-AMOS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:VITALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:204 S BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-9405
Mailing Address - Country:US
Mailing Address - Phone:234-801-4747
Mailing Address - Fax:
Practice Address - Street 1:204 S BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-9405
Practice Address - Country:US
Practice Address - Phone:234-801-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN278267363L00000X
CORN115701363L00000X
OHCOA-NP14020363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner