Provider Demographics
NPI:1336738608
Name:CHRIS AND ELZA HEALTHCARE, LLC
Entity type:Organization
Organization Name:CHRIS AND ELZA HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:561-801-0664
Mailing Address - Street 1:1665 DR MARTIN LUTHER KING JR BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-7126
Mailing Address - Country:US
Mailing Address - Phone:561-720-2443
Mailing Address - Fax:561-877-5042
Practice Address - Street 1:1665 DR MARTIN LUTHER KING JR BLVD STE 12
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-7126
Practice Address - Country:US
Practice Address - Phone:561-720-2443
Practice Address - Fax:561-877-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110363200Medicaid