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ELITE MEDICAL PROVIDERS LLC - Florida Company Profile

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Company Details

Entity Name: ELITE MEDICAL PROVIDERS LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 01 May 2024 (a year ago)
Document Number: L24000203972
FEI/EIN Number 99-2957432
Mail Address: 3601 NW FEDERAL HIGHWAY, JENSEN BEACH, FL, 34957
Address: 1701 SE HILLMOOR DRIVE, PORT SAINT LUCIE, FL, 34952, US
ZIP code: 34952
City: Port Saint Lucie
County: St. Lucie
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
WATT JASON MD Manager 3601 NW FEDERAL HIGHWAY, JENSEN BEACH, FL, 34957
BEISER NICOLE APRN Manager 1701 SE Hillmoor Drive, Port Saint Lucie, FL, 34952
DAWSON JOSE APRN Manager 1701 SE Hillmoor Drive, Port Saint Lucie, FL, 34952
VANDUZER DANIELLE MD Manager 1701 SE Hillmoor Drive, Port Saint Lucie, FL, 34952
COSTELLO FRANCINE CPA Agent 106 NW MADISON COURT, PORT SAINT LUCIE, FL, 34986

National Provider Identifier

NPI Number:
1003642877
Certification Date:
2024-09-10

Authorized Person:

Name:
FRANCINE COSTELLO
Role:
ACCOUNTANT
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Documents

Name Date
Florida Limited Liability 2024-05-01

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Date of last update: 01 Aug 2025

Sources: Florida Department of State