Healthcare Provider Details

I. General information

NPI: 1962373902
Provider Name (Legal Business Name): PRESTIGE PATIENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9506 ABERDARE AVE W
JACKSONVILLE FL
32208-1103
US

IV. Provider business mailing address

9506 ABERDARE AVE W
JACKSONVILLE FL
32208-1103
US

V. Phone/Fax

Practice location:
  • Phone: 904-662-8643
  • Fax: 904-662-8643
Mailing address:
  • Phone: 904-662-8643
  • Fax: 904-662-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: FELECIA THOMPSON
Title or Position: OWNER
Credential:
Phone: 904-662-8643