Provider Demographics
NPI:1235660366
Name:ACOSTA, ALEXIS (APRN-BC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 NW 42ND AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-4172
Mailing Address - Country:US
Mailing Address - Phone:305-504-7885
Mailing Address - Fax:
Practice Address - Street 1:860 NW 42ND AVE STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-4174
Practice Address - Country:US
Practice Address - Phone:305-504-7885
Practice Address - Fax:305-359-7546
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11031696363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty