Vivant Medical Group LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

VIVANT MEDICAL GROUP LLC

Practice address

6214 Memorial Hwy Ste B
Tampa, FL 33615-4507

Phone

(800) 574-9491

Fax

(800) 547-2802

NPI assigned

Feb 25, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Daphnee Moise-Johnson, MD

Title

President

Phone

(800) 574-9491

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625529600000",
    "number": "1124652425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6214 MEMORIAL HWY STE B",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336154507",
            "telephone_number": "800-574-9491",
            "fax_number": "800-547-2802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6214 MEMORIAL HWY STE B",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336154507",
            "telephone_number": "800-574-9491",
            "fax_number": "800-547-2802"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15600 Hancock Rd",
            "address_purpose": "LOCATION",
            "city": "Sarasota",
            "state": "FL",
            "postal_code": "342406701",
            "country_code": "US",
            "telephone_number": "813-924-5210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VIVANT MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-25",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A",
        "authorized_official_last_name": "MOISE-JOHNSON",
        "authorized_official_first_name": "DAPHNEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "800-574-9491",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273932100",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Tampa",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6214 Memorial Hwy Ste B",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336154507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Vivian Medina D.D.S P.a.
• Vivian Medina DDS PA
• Vivify Plastic Surgery LLC
• Isabella Vivino
• Sara Caridad Vizcay, MD

• General Practice Physician in Tampa, FL
• Providers in Tampa, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.