Healthcare Provider Details

I. General information

NPI: 1023693603
Provider Name (Legal Business Name): ELITE HEALTH ACCESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 02/14/2026
Certification Date: 02/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 SE 12TH CT
FORT LAUDERDALE FL
33316-2228
US

IV. Provider business mailing address

807 SE 12TH CT
FORT LAUDERDALE FL
33316-2228
US

V. Phone/Fax

Practice location:
  • Phone: 305-306-2880
  • Fax: 305-306-2889
Mailing address:
  • Phone: 305-306-2880
  • Fax: 305-306-2889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AUDREA VAUGHAN
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 305-306-2880