Provider Demographics
NPI:1033757562
Name:FERNANDEZ ACOSTA, ASTRID ELIZABETH
Entity Type:Individual
Prefix:
First Name:ASTRID
Middle Name:ELIZABETH
Last Name:FERNANDEZ ACOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 420686
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34742-0686
Mailing Address - Country:US
Mailing Address - Phone:321-877-8600
Mailing Address - Fax:
Practice Address - Street 1:3008 BONFIRE BEACH DR APT 102
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-5547
Practice Address - Country:US
Practice Address - Phone:321-877-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM-P100154171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator