Healthcare Provider Details

I. General information

NPI: 1144139247
Provider Name (Legal Business Name): ELITE FUNCTIONAL MEDICINE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 SE MONTEREY RD STE 202A
STUART FL
34996-3343
US

IV. Provider business mailing address

271 NE GRANDUER AVE
PORT ST LUCIE FL
34983-1288
US

V. Phone/Fax

Practice location:
  • Phone: 561-713-3772
  • Fax:
Mailing address:
  • Phone: 561-713-3772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRIA ROSE
Title or Position: AUTHORIZED OFFICIAL
Credential: NP
Phone: 561-713-3772