Provider Demographics
NPI:1336702109
Name:ELITE WOMENS CARE
Entity Type:Organization
Organization Name:ELITE WOMENS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNES
Authorized Official - Middle Name:
Authorized Official - Last Name:WIJNMAALEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-597-0907
Mailing Address - Street 1:11319 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5407
Mailing Address - Country:US
Mailing Address - Phone:352-597-0907
Mailing Address - Fax:
Practice Address - Street 1:11319 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5407
Practice Address - Country:US
Practice Address - Phone:352-597-0907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty