Healthcare Provider Details

I. General information

NPI: 1922532738
Provider Name (Legal Business Name): LUIS RAMON ACOSTA GONZALEZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S SEMORAN BLVD
ORLANDO FL
32807-2919
US

IV. Provider business mailing address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 407-587-7552
  • Fax: 833-450-5422
Mailing address:
  • Phone: 407-382-1376
  • Fax: 321-235-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11036557
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number17-226
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: