Healthcare Provider Details

I. General information

NPI: 1235057316
Provider Name (Legal Business Name): DAISY ACOSTA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12594 W MAWMAN AVE
BEACH PARK IL
60087-2027
US

IV. Provider business mailing address

12594 W MAWMAN AVE
BEACH PARK IL
60087-2027
US

V. Phone/Fax

Practice location:
  • Phone: 847-371-1615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025071271
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: