Provider Demographics
NPI:1639382922
Name:ACOSTA, DIGNA
Entity Type:Individual
Prefix:
First Name:DIGNA
Middle Name:
Last Name:ACOSTA
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 1:100 ARRICOLA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-4515
Mailing Address - Country:US
Mailing Address - Phone:904-825-4368
Mailing Address - Fax:904-797-7417
Practice Address - Street 1:100 ARRICOLA AVE
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-4515
Practice Address - Country:US
Practice Address - Phone:904-825-4368
Practice Address - Fax:904-797-7417
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23838183500000X
FLME73994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH02767Medicare UPIN