Healthcare Provider Details

I. General information

NPI: 1932171063
Provider Name (Legal Business Name): ANNETTE ACEVEDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNETTE ACEVEDO HERNANDEZ MD

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5615 S FLORIDA AVE STE 111
LAKELAND FL
33813-2714
US

IV. Provider business mailing address

6100 BLUE LAGOON DR STE 365
MIAMI FL
33126-7010
US

V. Phone/Fax

Practice location:
  • Phone: 863-327-0132
  • Fax: 863-777-2320
Mailing address:
  • Phone: 786-322-7333
  • Fax: 863-777-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN718
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number11973
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: