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General NPI Number Information
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NPI Number | 1962000174
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Entity Type | Organization
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Legal Business Name | ELITE PEDIATRIC HEALTHCARE, LLC
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 05/08/2021
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Provider Practice Location Address
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Address Line | 673 S KINGS AVENUE
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City | BRANDON
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State | FL
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Zip | 33511
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Country | US
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Telephone | 251-610-5615
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Fax |
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Provider Business Mailing Address
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Address Line | 19046 BRUCE B DOWNS BLVD # 1397
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City | TAMPA
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State | FL
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Zip | 33647
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/CO-OWNER
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Name | RHONDA NICHOLS MCGREW
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Credential | APRN, NP-C
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Telephone | 251-610-5615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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