Provider Demographics
NPI:1710254156
Name:ACOSTA, IVETTE
Entity Type:Individual
Prefix:MS
First Name:IVETTE
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 1:2365 NE 173RD ST APT 101
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4842
Mailing Address - Country:US
Mailing Address - Phone:305-978-8620
Mailing Address - Fax:
Practice Address - Street 1:2365 NE 173RD ST APT 101
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4842
Practice Address - Country:US
Practice Address - Phone:305-947-3567
Practice Address - Fax:305-947-3568
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL231867253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL231867OtherAGENCY FOR HEALTHCARE ADMINISTRATION