Provider Demographics
NPI:1972864197
Name:ELITE PRACTITIONERS OF TEXAS LLC
Entity Type:Organization
Organization Name:ELITE PRACTITIONERS OF TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP-C, CRNFA
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C, CRNFA
Authorized Official - Phone:832-600-5144
Mailing Address - Street 1:9022 MAJESTY LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5698
Mailing Address - Country:US
Mailing Address - Phone:832-500-5144
Mailing Address - Fax:
Practice Address - Street 1:9022 MAJESTY LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-5698
Practice Address - Country:US
Practice Address - Phone:832-500-5144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX680804363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty