Organization
BRANDON ANESTHESIA ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JORGE L. ACOSTA M.D. (PRESIDENT)
(813) 984-6263
Entity
Organization
Contact information
Practice address
119 OAKFIELD DR, BRANDON, FL 33511-5779
(813) 984-6263
Mailing address
PO BOX 861342, ORLANDO, FL 32886-1342
(813) 984-6263
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
379150500
—
FL
01
—
40376
BCBS
FL
01
—
CC4965
RAILROAD MEDICARE
FL
Enumeration date
03/22/2006
Last updated
01/25/2010
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