Healthcare Provider Details

I. General information

NPI: 1578305975
Provider Name (Legal Business Name): REYNALDO RUEDA ACOSTA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8748 SW 8TH ST
MIAMI FL
33174-3201
US

IV. Provider business mailing address

8748 SW 8TH ST
MIAMI FL
33174-3201
US

V. Phone/Fax

Practice location:
  • Phone: 786-665-6567
  • Fax: 540-304-2393
Mailing address:
  • Phone: 786-665-6567
  • Fax: 540-304-2393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11033293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: