Provider Demographics
NPI:1306802905
Name:D'ACOSTA, CHARLENE EDMEE (MD)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:EDMEE
Last Name:D'ACOSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:727-322-3439
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:10085 US HIGHWAY 19 STE GTE
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-3742
Practice Address - Country:US
Practice Address - Phone:727-810-8062
Practice Address - Fax:727-810-8064
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN813208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN813OtherMEDICAL LICENSE
FLBD9497000OtherDEA