Provider Demographics
NPI:1407083520
Name:BARTELT, ERICA ACOSTA (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:ACOSTA
Last Name:BARTELT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4313
Mailing Address - Country:US
Mailing Address - Phone:813-655-0292
Mailing Address - Fax:813-655-4302
Practice Address - Street 1:621 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4313
Practice Address - Country:US
Practice Address - Phone:813-655-0292
Practice Address - Fax:813-655-4302
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 112953208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006527600Medicaid