Healthcare Provider Details

I. General information

NPI: 1679351647
Provider Name (Legal Business Name): PRESTIGE MEDRESOURCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 BOWMAN ST STE 1
CLERMONT FL
34711-3144
US

IV. Provider business mailing address

1206 BOWMAN ST STE 1
CLERMONT FL
34711-3144
US

V. Phone/Fax

Practice location:
  • Phone: 352-702-7134
  • Fax:
Mailing address:
  • Phone: 352-702-7134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DONNA JACKSON SHARPE
Title or Position: CEO
Credential: CEO
Phone: 352-702-7134