MEDICARE: MS. LIANET ACOSTA ALFONSO APRN

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	363L00000X	Nurse Practitioner	11021455	FL

General Provider Information

NPI Number	:	1831810837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LIANET ACOSTA ALFONSO APRN

Provider Business Mailing Address
First Line	:	300 SW 107TH AVE STE 111
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33174-3601
Country	:	US
Telephone Number	:	786-660-5374
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 SW 107TH AVE STE 111
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33174-3601
Country	:	US
Telephone Number	:	786-660-5374
Fax Number	:

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

Provider Enumeration Date	:	09/07/2022
Last Update Date	:	09/07/2022

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