Provider Demographics
NPI:1932171063
Name:ACEVEDO, ANNETTE (MD)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:ACEVEDO HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6100 BLUE LAGOON DR STE 365
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-7010
Mailing Address - Country:US
Mailing Address - Phone:786-322-7333
Mailing Address - Fax:863-777-2320
Practice Address - Street 1:5615 S FLORIDA AVE STE 111
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2714
Practice Address - Country:US
Practice Address - Phone:863-327-0132
Practice Address - Fax:863-777-2320
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN718208D00000X
PR11973208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41808Medicare UPIN
PR0088443Medicare ID - Type Unspecified