# PRESTIGE SENIOR CARE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Prestige Senior Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275113565
- **Authorized official:** DR. KIMBERLY MIX MD (OWNER)
- **Authorized official phone:** (904) 545-5481

## Contact information

- **Practice address:** 10151 DEERWOOD PARK BLVD STE 250, JACKSONVILLE, FL 32256-0566
- **Practice address phone:** (800) 438-6702
- **Mailing address:** 8450 GATE PKWY W UNIT 1330, JACKSONVILLE, FL 32216-1072
- **Mailing address phone:** (904) 545-5481

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 04/11/2021
- **Last updated:** 04/11/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1154907897 | HOME HEALTH AIDE | FL |