Healthcare Provider Details

I. General information

NPI: 1871188664
Provider Name (Legal Business Name): JUDY LEE ACOSTA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 S STAPLEY DR STE 130
MESA AZ
85204-6677
US

IV. Provider business mailing address

18801 E VIA DE PALMAS
QUEEN CREEK AZ
85142-4044
US

V. Phone/Fax

Practice location:
  • Phone: 888-777-1945
  • Fax: 805-413-9099
Mailing address:
  • Phone: 480-202-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number254583
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: