Provider Demographics
NPI:1184647778
Name:ACEVEDO, BETZY (DRA)
Entity Type:Individual
Prefix:MRS
First Name:BETZY
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:DRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 WESTWOOD BLVD STE 475
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6027
Mailing Address - Country:US
Mailing Address - Phone:407-845-0330
Mailing Address - Fax:888-972-1752
Practice Address - Street 1:1044 PLAZA DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-4064
Practice Address - Country:US
Practice Address - Phone:407-933-7900
Practice Address - Fax:321-437-0072
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15642208D00000X
FLACN810208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1245954OtherWELLCARE
FLP01800814OtherSIMPLY
FLP977394OtherOPTIMUM
FLP1043312OtherFREEDOM
FL1134162OtherCAREPLUS
FLHPY9ZOtherFLORIDA BLUE