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Organization
PRESTIGE SENIOR CARE
Active
Organization
PRESTIGE SENIOR CARE
Active
Other names
Prestige Senior Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIMBERLY MIX MD (OWNER)
(904) 545-5481
Entity
Organization
Contact information
Practice address
10151 DEERWOOD PARK BLVD STE 250, JACKSONVILLE, FL 32256-0566
(800) 438-6702
Mailing address
8450 GATE PKWY W UNIT 1330, JACKSONVILLE, FL 32216-1072
(904) 545-5481
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
NULL
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1154907897
HOME HEALTH AIDE
FL
Enumeration date
04/11/2021
Last updated
04/11/2021
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