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General NPI Number Information
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NPI Number | 1124999453
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Entity Type | Organization
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Legal Business Name | PRESTIGE INTEGRATED HEALTHCARE SOLUTIONS LLC
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 9623 SE 110TH STREET RD
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City | BELLEVIEW
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State | FL
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Zip | 34420-3661
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Country | US
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Telephone | 352-605-2520
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Fax | 813-755-3366
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Provider Business Mailing Address
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Address Line | PO BOX 161
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City | BELLEVIEW
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State | FL
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Zip | 34421-0161
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Country | US
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Telephone | 352-605-2520
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Fax | 813-755-3366
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DEREK BRUNER
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Credential |
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Telephone | 352-239-5958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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