Provider Demographics
NPI:1124999453
Name:PRESTIGE INTEGRATED HEALTHCARE SOLUTIONS LLC
Entity type:Organization
Organization Name:PRESTIGE INTEGRATED HEALTHCARE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-239-5958
Mailing Address - Street 1:PO BOX 161
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34421-0161
Mailing Address - Country:US
Mailing Address - Phone:352-605-2520
Mailing Address - Fax:813-755-3366
Practice Address - Street 1:9623 SE 110TH STREET RD
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-3661
Practice Address - Country:US
Practice Address - Phone:352-605-2520
Practice Address - Fax:813-755-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-17
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty