Provider Demographics
NPI:1447003306
Name:ACEVEDO IGLESIAS, LINETTE (MD)
Entity type:Individual
Prefix:
First Name:LINETTE
Middle Name:
Last Name:ACEVEDO IGLESIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10628 ALDO MORO DR
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-0019
Mailing Address - Country:US
Mailing Address - Phone:813-291-1266
Mailing Address - Fax:
Practice Address - Street 1:1006 W PLEASANT ST
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-2966
Practice Address - Country:US
Practice Address - Phone:863-314-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN39163390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program