Healthcare Provider Details

I. General information

NPI: 1427984939
Provider Name (Legal Business Name): ELEVATE HEALTH 360 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13441 SW 17TH CT
MIRAMAR FL
33027-3447
US

IV. Provider business mailing address

13441 SW 17TH CT
MIRAMAR FL
33027-3447
US

V. Phone/Fax

Practice location:
  • Phone: 754-301-0615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FARIDA VILDANOVA
Title or Position: OWNER AND MANAGING MEMBER
Credential: FNP-BC
Phone: 754-301-0615