Healthcare Provider Details

I. General information

NPI: 1962405852
Provider Name (Legal Business Name): ANDRES R ACOSTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6716 NW 11TH PLACE STE 200
GAINESVILLE FL
32605-4215
US

IV. Provider business mailing address

6716 NW 11TH PLACE STE 200
GAINESVILLE FL
32605-4215
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-9729
  • Fax: 352-371-3372
Mailing address:
  • Phone: 352-331-9729
  • Fax: 352-371-3372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME82462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: