| Entity Name: | ELITE MEDICAL PROVIDERS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 01 May 2024 (9 months ago) |
| Document Number: | L24000203972 |
| Address: | 1701 SE HILLMOOR DRIVE, #17, PORT SAINT LUCIE, FL 34952 |
| Mail Address: | 3601 NW FEDERAL HIGHWAY, JENSEN BEACH, FL 34957 |
| ZIP code: | 34952 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003642877 | 2024-09-10 | 2024-09-10 | 1701 SE HILLMOOR DR # 17, PORT SAINT LUCIE, FL, 349527552, US | 1701 SE HILLMOOR DR # 17, PORT SAINT LUCIE, FL, 349527552, US | |||||||||||||
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| Phone | +1 772-207-0697 |
Authorized person
| Name | FRANCINE COSTELLO |
| Role | ACCOUNTANT |
| Phone | 7725289991 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| COSTELLO, FRANCINE, CPA | Agent | 106 NW MADISON COURT, PORT SAINT LUCIE, FL 34986 |
| Name | Role | Address |
|---|---|---|
| WATT, JASON, MD | Manager | 3601 NW FEDERAL HIGHWAY, JENSEN BEACH, FL 34957 |
| BEISER, NICOLE, APRN | Manager | 3601 NW FEDERAL HIGHWAY, JENSEN BEACH, FL 34957 |
| DAWSON, JOSE, APRN | Manager | 3601 NW FEDERAL HIGHWAY, JENSEN BEACH, FL 34957 |
| VANDUZER, DANIELLE, APRN | Manager | 3601 NW FEDERAL HIGHWAY, JENSEN BEACH, FL 34957 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-05-01 |
Date of last update: 07 Jan 2025
Sources: Florida Department of State
