Healthcare Provider Details

I. General information

NPI: 1851071708
Provider Name (Legal Business Name): PRESTIGE EXPRESS ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NW 8TH AVE SUITE
B-10 FL
32601
US

IV. Provider business mailing address

1481 SE 36TH ST
GAINESVILLE FL
32641-8854
US

V. Phone/Fax

Practice location:
  • Phone: 877-242-9816
  • Fax:
Mailing address:
  • Phone: 904-942-1305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: LAKEISHA ANN KELLY
Title or Position: PRESIDENT
Credential:
Phone: 904-942-1305