MEDICARE: CHARLENE EDMEE D'ACOSTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	ACN813	FL

General Provider Information

NPI Number	:	1306802905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE EDMEE D'ACOSTA MD

Provider Business Mailing Address
First Line	:	601 S HARBOUR ISLAND BLVD STE 200
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-5925
Country	:	US
Telephone Number	:	727-322-3439
Fax Number	:	800-928-7449

Provider Business Practice Location Address
First Line	:	10085 US HIGHWAY 19 STE GTE
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-3742
Country	:	US
Telephone Number	:	727-810-8062
Fax Number	:	727-810-8064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2006
Last Update Date	:	07/16/2025

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