Healthcare Provider Details

I. General information

NPI: 1235660366
Provider Name (Legal Business Name): ALEXIS ACOSTA APRN-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 NW 42ND AVE STE 101
MIAMI FL
33126-4174
US

IV. Provider business mailing address

860 NW 42ND AVE FL 5
MIAMI FL
33126-4172
US

V. Phone/Fax

Practice location:
  • Phone: 305-504-7885
  • Fax: 305-359-7546
Mailing address:
  • Phone: 305-504-7885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11031696
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: