MEDICARE: ELEVATE HEALTH AND 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A549M	OTHER		BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1437893211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE HEALTH AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1765
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-1765
Country	:	US
Telephone Number	:	850-972-9262
Fax Number	:	850-403-5533

Provider Business Practice Location Address
First Line	:	327 S COUNTY HIGHWAY 393 UNIT 201
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-8209
Country	:	US
Telephone Number	:	850-972-9262
Fax Number	:	850-403-5533

Authorized Official
Title or Position	:	OWNER
Name	:	LYNDE JONES
Credential	:	APRN
Telephone Number	:	850-972-9262

Provider Enumeration Date	:	04/26/2022
Last Update Date	:	04/26/2022

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Directions to “ELEVATE HEALTH AND WELLNESS, LLC ” Practice Location

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