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General NPI Number Information
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NPI Number | 1710599303
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Entity Type | Organization
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Legal Business Name | ELITE MEDICAL PARTNERS PLLC
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Dates
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Enumeration Date | 08/17/2020
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 20261 E OCOTILLO RD STE 110
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-8806
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Country | US
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Telephone | 480-805-1444
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Fax | 480-677-2768
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Provider Business Mailing Address
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Address Line | 20261 E OCOTILLO RD STE 110
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-8806
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Country | US
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Telephone | 480-805-1444
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Fax | 480-677-2768
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Authorized Official
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Title or Position | OWNER
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Name | JILLIAN TRULSON
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Credential | PA-C
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Telephone | 480-227-6683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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