Provider Demographics
NPI:1922532738
Name:ACOSTA GONZALEZ, LUIS RAMON (APRN)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:RAMON
Last Name:ACOSTA GONZALEZ
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 1:425 W COLONIAL DR STE 303
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6863
Mailing Address - Country:US
Mailing Address - Phone:407-382-1376
Mailing Address - Fax:321-235-3232
Practice Address - Street 1:1130 S SEMORAN BLVD STE B-C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1457
Practice Address - Country:US
Practice Address - Phone:407-382-1376
Practice Address - Fax:321-235-3232
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-226246ZC0007X
FLAPRN11036557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL125357200Medicaid