Provider Demographics
NPI:1689617920
Name:ACOSTA, NILDA R (MD)
Entity Type:Individual
Prefix:
First Name:NILDA
Middle Name:R
Last Name:ACOSTA
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 1:1443 NE 8 STREET
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033
Mailing Address - Country:US
Mailing Address - Phone:305-246-3864
Mailing Address - Fax:
Practice Address - Street 1:1443 NE 8 STREET
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033
Practice Address - Country:US
Practice Address - Phone:305-246-3864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 61179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373407201Medicaid
FL31477AMedicare ID - Type UnspecifiedMEDICARE