Healthcare Provider Details

I. General information

NPI: 1194239384
Provider Name (Legal Business Name): ATZA M ACOSTA FELICIANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 W LUMSDEN RD
BRANDON FL
33511-8821
US

IV. Provider business mailing address

1989 W LUMSDEN RD
BRANDON FL
33511-8821
US

V. Phone/Fax

Practice location:
  • Phone: 813-653-3111
  • Fax: 813-653-1384
Mailing address:
  • Phone: 813-653-3111
  • Fax: 813-653-1384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME133710
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: