Healthcare Provider Details

I. General information

NPI: 1598392946
Provider Name (Legal Business Name): PRESTIGE TOTAL HEALTH OF FLORIDA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 BUTTER OAKS CT
WINTER GARDEN FL
34787-2014
US

IV. Provider business mailing address

912 BUTTER OAKS CT
WINTER GARDEN FL
34787-2014
US

V. Phone/Fax

Practice location:
  • Phone: 919-744-1592
  • Fax: 844-339-2908
Mailing address:
  • Phone: 919-744-1592
  • Fax: 844-339-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAUREN ASHLEY SCHNEIDER
Title or Position: OWNER
Credential: APRN
Phone: 407-656-6562