Healthcare Provider Details

I. General information

NPI: 1134657612
Provider Name (Legal Business Name): DAVID RICARDO ACOSTA VILLAMIZAR SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6715 RIVER RD
TAMPA FL
33615-2809
US

IV. Provider business mailing address

6715 RIVER RD
TAMPA FL
33615-2809
US

V. Phone/Fax

Practice location:
  • Phone: 813-327-1400
  • Fax:
Mailing address:
  • Phone: 813-327-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number17-321
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: