=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891630471
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELEVATE MEN'S HEALTH 365
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2026
-----------------------------------------------------
Last Update Date | 04/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1317 EDGEWATER DR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32804-6350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-612-2548
-----------------------------------------------------
Fax | 407-887-5723
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1317 EDGEWATER DR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32804-6350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-612-2548
-----------------------------------------------------
Fax | 407-887-5723
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER AND CEO
-----------------------------------------------------
Name | DR. SCOTT ROBERT MCNEILL
-----------------------------------------------------
Credential | DNP
-----------------------------------------------------
Telephone | 407-580-6913
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------