Provider Demographics
NPI:1942972955
Name:ACOSTA CARDENAS, KLEYSIS (APRN)
Entity Type:Individual
Prefix:
First Name:KLEYSIS
Middle Name:
Last Name:ACOSTA CARDENAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 TUSKEGEE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-2121
Mailing Address - Country:US
Mailing Address - Phone:561-201-3743
Mailing Address - Fax:
Practice Address - Street 1:3540 FOREST HILL BLVD STE 205
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5878
Practice Address - Country:US
Practice Address - Phone:561-770-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily