Provider Demographics
NPI:1083016737
Name:ACOSTA, MERCEDES CARIDAD (ARNP)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:CARIDAD
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4790 BARKLEY CIR STE A
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7593
Mailing Address - Country:US
Mailing Address - Phone:239-275-8882
Mailing Address - Fax:239-275-6304
Practice Address - Street 1:4790 BARKLEY CIR STE A
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7593
Practice Address - Country:US
Practice Address - Phone:239-275-8882
Practice Address - Fax:239-275-6304
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9264259363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013464900Medicaid
FLIA767ZMedicare UPIN