Healthcare Provider Details

I. General information

NPI: 1831719756
Provider Name (Legal Business Name): ELITE AESTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3612 S ATLANTIC AVE
DAYTONA BEACH SHORES FL
32118-7602
US

IV. Provider business mailing address

2704 S PENINSULA DR
DAYTONA BEACH FL
32118-5706
US

V. Phone/Fax

Practice location:
  • Phone: 386-872-5442
  • Fax: 386-872-3018
Mailing address:
  • Phone: 386-872-5442
  • Fax: 386-872-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA METAKES
Title or Position: APRN/OWNER
Credential: APRN
Phone: 386-872-5442