Healthcare Provider Details

I. General information

NPI: 1881022531
Provider Name (Legal Business Name): INGRID ACOSTA B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 GARDEN ISLE CT APT A203
ORLANDO FL
32824
US

IV. Provider business mailing address

1225 GARDEN ISLE CT APT A203
ORLANDO FL
32824-6218
US

V. Phone/Fax

Practice location:
  • Phone: 407-990-2847
  • Fax:
Mailing address:
  • Phone: 407-990-2847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI2530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: