Healthcare Provider Details

I. General information

NPI: 1891621264
Provider Name (Legal Business Name): SOFIA ACOSTA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONG SHOALS RD APT 1O
ARDEN NC
28704-7717
US

IV. Provider business mailing address

300 LONG SHOALS RD APT 1O
ARDEN NC
28704-7717
US

V. Phone/Fax

Practice location:
  • Phone: 954-778-3056
  • Fax:
Mailing address:
  • Phone: 954-778-3056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: