Provider Demographics
NPI:1528887247
Name:ACEVEDO, LUZ LEIDA (RN, BSN)
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:LEIDA
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 DUNRAVEN CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-5357
Mailing Address - Country:US
Mailing Address - Phone:352-216-8907
Mailing Address - Fax:
Practice Address - Street 1:4702 TARGET BLVD STE 16
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-5313
Practice Address - Country:US
Practice Address - Phone:689-200-7864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9373690163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy