Provider Demographics
NPI:1437893211
Name:ELEVATE HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:ELEVATE HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:850-972-9262
Mailing Address - Street 1:PO BOX 1765
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-1765
Mailing Address - Country:US
Mailing Address - Phone:850-972-9262
Mailing Address - Fax:850-403-5533
Practice Address - Street 1:327 S COUNTY HIGHWAY 393 UNIT 201
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-8209
Practice Address - Country:US
Practice Address - Phone:850-972-9262
Practice Address - Fax:850-403-5533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A549MOtherBLUECROSS BLUESHIELD