Provider Demographics
NPI:1750496998
Name:ACOSTA, ZONIA D
Entity Type:Individual
Prefix:
First Name:ZONIA
Middle Name:D
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 1:4004 N OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-6420
Mailing Address - Country:US
Mailing Address - Phone:954-564-1330
Mailing Address - Fax:954-564-0538
Practice Address - Street 1:4004 N OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-6420
Practice Address - Country:US
Practice Address - Phone:954-564-1330
Practice Address - Fax:954-564-0538
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69184207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250885100Medicaid
FL250885100Medicaid
FLG35221Medicare UPIN