MEDICARE: MS. IVETTE ACOSTA

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	253Z00000X	In Home Supportive Care Agency	231867	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	231867	OTHER	FL	AGENCY FOR HEALTHCARE ADMINISTRATION

General Provider Information

NPI Number	:	1710254156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IVETTE ACOSTA

Provider Business Mailing Address
First Line	:	2365 NE 173RD ST APT 101
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4842
Country	:	US
Telephone Number	:	305-978-8620
Fax Number	:

Provider Business Practice Location Address
First Line	:	2365 NE 173RD ST APT 101
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4842
Country	:	US
Telephone Number	:	305-947-3567
Fax Number	:	305-947-3568

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

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	11/30/2011

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