Provider Demographics
NPI:1326775016
Name:ELITE PSYCHIATRY SPECIALIST
Entity Type:Organization
Organization Name:ELITE PSYCHIATRY SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLUKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-997-2099
Mailing Address - Street 1:88 LOCHNAGAR MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-6672
Mailing Address - Country:US
Mailing Address - Phone:812-870-8683
Mailing Address - Fax:
Practice Address - Street 1:88 LOCHNAGAR MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-6672
Practice Address - Country:US
Practice Address - Phone:812-870-8683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty