Provider Demographics
NPI:1104308162
Name:ACOSTA, VICENTE AUGUSTO (RN)
Entity type:Individual
Prefix:
First Name:VICENTE
Middle Name:AUGUSTO
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 NW 133RD AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2745
Mailing Address - Country:US
Mailing Address - Phone:954-551-0557
Mailing Address - Fax:
Practice Address - Street 1:1323 NW 133RD AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2745
Practice Address - Country:US
Practice Address - Phone:954-551-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9415542163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty