Healthcare Provider Details

I. General information

NPI: 1659122539
Provider Name (Legal Business Name): IVAN ACEVEDO PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 SW 57TH AVE STE 106
MIAMI FL
33155-2164
US

IV. Provider business mailing address

1890 SW 57TH AVE STE 106 106
MIAMI FL
33155-2164
US

V. Phone/Fax

Practice location:
  • Phone: 786-536-1701
  • Fax: 305-847-2447
Mailing address:
  • Phone: 786-536-1701
  • Fax: 305-847-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11032059
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11032059
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: