Healthcare Provider Details

I. General information

NPI: 1093047672
Provider Name (Legal Business Name): LAURA JANE ACOSTA MS, RD, LD/N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA JANE JENSEN MS, RD, LD/N

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610
US

IV. Provider business mailing address

1600 SW ARCHER RD BOX 100236
GAINESVILLE FL
32610-0236
US

V. Phone/Fax

Practice location:
  • Phone: 352-375-1158
  • Fax:
Mailing address:
  • Phone: 352-375-1158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND5247
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: