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
—
—
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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