Provider Demographics
NPI:1336986827
Name:ELEVATE PRIMARY CARE & WELLNESS LLC
Entity type:Organization
Organization Name:ELEVATE PRIMARY CARE & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NELA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BALLESTEROS MOYANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-310-3102
Mailing Address - Street 1:107 LAKE EMMA COVE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2508
Mailing Address - Country:US
Mailing Address - Phone:407-310-3102
Mailing Address - Fax:
Practice Address - Street 1:107 LAKE EMMA COVE DR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2508
Practice Address - Country:US
Practice Address - Phone:407-310-3102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty