Healthcare Provider Details

I. General information

NPI: 1508196999
Provider Name (Legal Business Name): STEPHANIE MYREL ACOSTA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13943 N 91ST AVE STE I
PEORIA AZ
85381-3692
US

IV. Provider business mailing address

13943 N 91ST AVE STE I
PEORIA AZ
85381-3692
US

V. Phone/Fax

Practice location:
  • Phone: 623-815-2690
  • Fax: 623-815-2689
Mailing address:
  • Phone: 623-815-2690
  • Fax: 623-815-2689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number202209765RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number334581
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95185761
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNUR-APRN-LIC-234817
License Number StateMT
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704413416
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2523379
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704413416
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNUR-APRN-LIC-234817
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: