Provider Demographics
NPI:1912516410
Name:ACOSTA ESTEVEZ, ALBA LOURDES
Entity Type:Individual
Prefix:
First Name:ALBA
Middle Name:LOURDES
Last Name:ACOSTA ESTEVEZ
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 1:17730 NW 67TH AVE APT 514
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5809
Mailing Address - Country:US
Mailing Address - Phone:786-343-2091
Mailing Address - Fax:
Practice Address - Street 1:17730 NW 67TH AVE APT 514
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5809
Practice Address - Country:US
Practice Address - Phone:786-343-2091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty