Healthcare Provider Details

I. General information

NPI: 1598011785
Provider Name (Legal Business Name): JESSICA LYNN ACOSTA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E HIGHLAND AVE STE 400
PHOENIX AZ
85016-4880
US

IV. Provider business mailing address

1760 E RIVER RD STE 350
TUCSON AZ
85718-5999
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-4868
  • Fax: 602-230-9350
Mailing address:
  • Phone: 520-519-7700
  • Fax: 520-519-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0612491
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4571
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: