MEDICARE: LUZ LEIDA ACEVEDO RN, BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WI0500X	Infusion Therapy Registered Nurse	9373690	FL

General Provider Information

NPI Number	:	1528887247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ LEIDA ACEVEDO RN, BSN

Provider Business Mailing Address
First Line	:	2622 DUNRAVEN CT
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34743-5357
Country	:	US
Telephone Number	:	352-216-8907
Fax Number	:

Provider Business Practice Location Address
First Line	:	4702 TARGET BLVD STE 16
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-5313
Country	:	US
Telephone Number	:	689-200-7864
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/09/2024

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