Healthcare Provider Details

I. General information

NPI: 1710599303
Provider Name (Legal Business Name): ELITE MEDICAL PARTNERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20261 E OCOTILLO RD STE 110
QUEEN CREEK AZ
85142-8806
US

IV. Provider business mailing address

20261 E OCOTILLO RD STE 110
QUEEN CREEK AZ
85142-8806
US

V. Phone/Fax

Practice location:
  • Phone: 480-805-1444
  • Fax: 480-677-2768
Mailing address:
  • Phone: 480-805-1444
  • Fax: 480-677-2768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JILLIAN TRULSON
Title or Position: OWNER
Credential: PA-C
Phone: 480-227-6683