MEDICARE: ELM & VINE WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1427911478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELM & VINE WELLNESS LLC

Provider Business Mailing Address
First Line	:	8725 SW 213TH TER
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-7303
Country	:	US
Telephone Number	:	786-255-0246
Fax Number	:

Provider Business Practice Location Address
First Line	:	8725 SW 213TH TER
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-7303
Country	:	US
Telephone Number	:	786-255-0246
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SARA CHAMPION
Credential	:	APRN
Telephone Number	:	786-255-0246

Provider Enumeration Date	:	12/06/2025
Last Update Date	:	12/06/2025

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