Healthcare Provider Details

I. General information

NPI: 1356922058
Provider Name (Legal Business Name): IRENE ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 SW 99TH AVE STE 102B
MIAMI FL
33173-4668
US

IV. Provider business mailing address

505 NW 177TH ST APT 109
MIAMI GARDENS FL
33169-6910
US

V. Phone/Fax

Practice location:
  • Phone: 305-282-7103
  • Fax: 866-372-3732
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9644308
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number524319
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: