Healthcare Provider Details

I. General information

NPI: 1912689662
Provider Name (Legal Business Name): ILEANA FERNANDA ACOSTA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12655 COLLIER BLVD
NAPLES FL
34116-4005
US

IV. Provider business mailing address

12655 COLLIER BLVD
NAPLES FL
34116-4005
US

V. Phone/Fax

Practice location:
  • Phone: 239-658-3000
  • Fax:
Mailing address:
  • Phone: 954-557-1382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11025055
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number11025055
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: