Provider Demographics
NPI:1821852799
Name:MIXSON, AKILI
Entity Type:Individual
Prefix:
First Name:AKILI
Middle Name:
Last Name:MIXSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 IVA PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-3586
Mailing Address - Country:US
Mailing Address - Phone:904-566-1572
Mailing Address - Fax:
Practice Address - Street 1:550 BALMORAL CIR N STE 302
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-5583
Practice Address - Country:US
Practice Address - Phone:904-566-1572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X, 251S00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health