Provider Demographics
NPI:1376807446
Name:SENIORELITE LLC
Entity Type:Organization
Organization Name:SENIORELITE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIVIENNE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:813-482-1743
Mailing Address - Street 1:14902 WINDING CREEK CT
Mailing Address - Street 2:STE 105C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1640
Mailing Address - Country:US
Mailing Address - Phone:813-482-1743
Mailing Address - Fax:
Practice Address - Street 1:14902 WINDING CREEK CT
Practice Address - Street 2:STE 105C
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1640
Practice Address - Country:US
Practice Address - Phone:813-482-1743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty