Provider Demographics
NPI:1538038914
Name:GRINAN ACOSTA, RAIKO NESTOR (APRN)
Entity type:Individual
Prefix:
First Name:RAIKO
Middle Name:NESTOR
Last Name:GRINAN ACOSTA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 NW 15TH ST STE 6-7
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2988
Mailing Address - Country:US
Mailing Address - Phone:305-537-4766
Mailing Address - Fax:305-675-2860
Practice Address - Street 1:1565 W 29TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5516
Practice Address - Country:US
Practice Address - Phone:305-537-4100
Practice Address - Fax:305-675-2860
Is Sole Proprietor?:No
Enumeration Date:2025-11-03
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11043348363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily