Provider Demographics
NPI:1164825972
Name:ACOSTA AVILA, TERESA O
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:O
Last Name:ACOSTA AVILA
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 1:14015 SW 42ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3639
Mailing Address - Country:US
Mailing Address - Phone:305-826-5887
Mailing Address - Fax:305-362-1559
Practice Address - Street 1:14015 SW 42ND TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3639
Practice Address - Country:US
Practice Address - Phone:305-826-5887
Practice Address - Fax:305-362-1559
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9391839363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner