Provider Demographics
NPI:1386036150
Name:ACOSTA, IRMA (PA-C)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N PARK AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4101
Mailing Address - Country:US
Mailing Address - Phone:407-886-1300
Mailing Address - Fax:
Practice Address - Street 1:203 N PARK AVE STE 101
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4101
Practice Address - Country:US
Practice Address - Phone:407-886-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108058363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical