MEDICARE: ALEXA MONAE ACOSTA FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP143209	TX

General Provider Information

NPI Number	:	1689215675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA MONAE ACOSTA FNP-BC

Provider Business Mailing Address
First Line	:	8524 MORLEY DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-4906
Country	:	US
Telephone Number	:	915-867-1196
Fax Number	:

Provider Business Practice Location Address
First Line	:	1382 LOMALAND DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79935-5204
Country	:	US
Telephone Number	:	915-633-1209
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2019
Last Update Date	:	10/01/2019

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