Healthcare Provider Details

I. General information

NPI: 1588578298
Provider Name (Legal Business Name): LIAN ACOSTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 SW 6TH CT STE 110
PLANTATION FL
33324-3248
US

IV. Provider business mailing address

19256 NW 67TH PL
HIALEAH FL
33015-2477
US

V. Phone/Fax

Practice location:
  • Phone: 877-455-7300
  • Fax:
Mailing address:
  • Phone: 786-719-9484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11040922
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: