Healthcare Provider Details

I. General information

NPI: 1992621957
Provider Name (Legal Business Name): AILYN ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 SUSAN AVE S
LEHIGH ACRES FL
33976-2329
US

IV. Provider business mailing address

57 SUSAN AVE S
LEHIGH ACRES FL
33976-2329
US

V. Phone/Fax

Practice location:
  • Phone: 863-368-9186
  • Fax:
Mailing address:
  • Phone: 863-368-9186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number17732-I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: