| Entity Name: | NILDA ACOSTA MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 16 Oct 1995 (29 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | P95000079929 |
| FEI/EIN Number | 650619943 |
| Address: | 10899 SW 72ND ST, MIAMI, FL, 33173, US |
| Mail Address: | 10899 SW 72ND ST, MIAMI, FL, 33173, US |
| ZIP code: | 33173 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033223003 | 2006-08-18 | 2013-02-26 | 1235 N KROME AVE, HOMESTEAD, FL, 330304204, US | 1235 N KROME AVE, HOMESTEAD, FL, 330304204, US | |||||||||||||||||||||||||||||
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| Phone | +1 305-242-5336 |
| Fax | 3052425337 |
Authorized person
| Name | NILDA ACOSTA |
| Role | MANAGED CARE SPECIALIST |
| Phone | 8006540889 |
Taxonomy
| Taxonomy Code | 332900000X - Non-Pharmacy Dispensing Site |
| License Number | ME61179 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | OTHER ID NUMBER-COMMERCIAL NUMBER |
| Number | 1019149 |
| Issuer | MEDICAID |
| Number | 373407201 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MARTINEZ HUGO | Agent | 10899 SW 72ND ST, MIAMI, FL, 33173 |
| Name | Role | Address |
|---|---|---|
| ACOSTA NILDA R | President | 22455 SW 182 AVE, MIAMI, FL, 33170 |
| Name | Role | Address |
|---|---|---|
| ACOSTA NILDA R | Secretary | 22455 SW 182 AVE, MIAMI, FL, 33170 |
| Name | Role | Address |
|---|---|---|
| ACOSTA NILDA R | Treasurer | 22455 SW 182 AVE, MIAMI, FL, 33170 |
| Name | Role | Address |
|---|---|---|
| ACOSTA NILDA R | Director | 22455 SW 182 AVE, MIAMI, FL, 33170 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-07-15 | 10899 SW 72ND ST, 203, MIAMI, FL 33173 | No data |
| CHANGE OF MAILING ADDRESS | 2016-07-15 | 10899 SW 72ND ST, 203, MIAMI, FL 33173 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-07-15 | MARTINEZ, HUGO | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-07-15 | 10899 SW 72ND ST, 203, MIAMI, FL 33173 | No data |
| AMENDMENT AND NAME CHANGE | 2013-02-15 | NILDA ACOSTA MD PA | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-07-15 |
| ANNUAL REPORT | 2015-03-09 |
| ANNUAL REPORT | 2014-04-30 |
| Amendment and Name Change | 2013-02-15 |
| ANNUAL REPORT | 2013-01-30 |
| ANNUAL REPORT | 2012-04-26 |
| ANNUAL REPORT | 2011-03-16 |
| ANNUAL REPORT | 2010-02-11 |
| ANNUAL REPORT | 2009-02-19 |
| ANNUAL REPORT | 2008-04-23 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
