=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265656474
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEAH L ACERO ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2007
-----------------------------------------------------
Last Update Date | 10/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3663 S MIAMI AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33133-4253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-854-0616
-----------------------------------------------------
Fax | 305-836-7101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 799 CURTISWOOD DR
-----------------------------------------------------
City | KEY BISCAYNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33149-2404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-361-0860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | ARNP 9176123
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine Nurse Practitioner
-----------------------------------------------------
License Number | ARNP9176123
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------