Provider Demographics
NPI:1962868810
Name:ELITE NURSE PRACTITIONERS, LLC
Entity type:Organization
Organization Name:ELITE NURSE PRACTITIONERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ AMPUDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-726-7888
Mailing Address - Street 1:6646 SW 63RD TER
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-2023
Mailing Address - Country:US
Mailing Address - Phone:305-726-7888
Mailing Address - Fax:
Practice Address - Street 1:6646 SW 63RD TER
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-2023
Practice Address - Country:US
Practice Address - Phone:305-726-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9265567363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty