Healthcare Provider Details

I. General information

NPI: 1326859778
Provider Name (Legal Business Name): JOSE A ACOSTA FERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 COLLEGE PKWY STE 107
FORT MYERS FL
33919-4111
US

IV. Provider business mailing address

416 NW 7TH TER
CAPE CORAL FL
33993-1886
US

V. Phone/Fax

Practice location:
  • Phone: 239-360-7963
  • Fax: 239-360-7967
Mailing address:
  • Phone: 239-412-1384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: