Healthcare Provider Details

I. General information

NPI: 1821852799
Provider Name (Legal Business Name): AKILI MIXSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 BALMORAL CIR N STE 302
JACKSONVILLE FL
32218-5583
US

IV. Provider business mailing address

646 IVA PL
JACKSONVILLE FL
32208-3586
US

V. Phone/Fax

Practice location:
  • Phone: 904-566-1572
  • Fax:
Mailing address:
  • Phone: 904-566-1572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: