Healthcare Provider Details

I. General information

NPI: 1407083520
Provider Name (Legal Business Name): ERICA ACOSTA BARTELT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 VICTORIA ST
BRANDON FL
33510-4313
US

IV. Provider business mailing address

621 VICTORIA ST
BRANDON FL
33510-4313
US

V. Phone/Fax

Practice location:
  • Phone: 813-655-0292
  • Fax: 813-655-4302
Mailing address:
  • Phone: 813-655-0292
  • Fax: 813-655-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 112953
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: