Provider Demographics
NPI:1558995464
Name:ACOSTA VALLE, IRAIDA MARIA (NP)
Entity Type:Individual
Prefix:
First Name:IRAIDA
Middle Name:MARIA
Last Name:ACOSTA VALLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 SW 127TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-1355
Mailing Address - Country:US
Mailing Address - Phone:786-339-5135
Mailing Address - Fax:
Practice Address - Street 1:14283 SW 42ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6408
Practice Address - Country:US
Practice Address - Phone:305-226-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-29
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily