Provider Demographics
NPI:1841812625
Name:PORTER ELITE CARE SERVICES LLC
Entity type:Organization
Organization Name:PORTER ELITE CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:561-402-1779
Mailing Address - Street 1:789 SW FEDERAL HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2962
Mailing Address - Country:US
Mailing Address - Phone:561-402-1779
Mailing Address - Fax:949-655-6039
Practice Address - Street 1:789 SW FEDERAL HWY STE 201
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2962
Practice Address - Country:US
Practice Address - Phone:561-402-1779
Practice Address - Fax:949-655-6039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1104467877Medicaid