1265656474 NPI number — MISS LEAH L ACERO ARNP

Table of content: MISS LEAH L ACERO ARNP (NPI 1265656474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265656474 NPI number — MISS LEAH L ACERO ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ACERO
Provider First Name:
LEAH
Provider Middle Name:
L
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORAN
Provider Other First Name:
LEAH
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265656474
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
799 CURTISWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEY BISCAYNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33149-2404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-361-0860
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3663 S MIAMI AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33133-4253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-854-0616
Provider Business Practice Location Address Fax Number:
305-836-7101
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  ARNP 9176123 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LC0200X , with the licence number: ARNP9176123 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 023908000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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