Healthcare Provider Details

I. General information

NPI: 1386267011
Provider Name (Legal Business Name): ANN MARY GRAHAM ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 ENGLISH OAK CT
WALDORF MD
20601-4505
US

IV. Provider business mailing address

2014 ENGLISH OAK CT
WALDORF MD
20601-4505
US

V. Phone/Fax

Practice location:
  • Phone: 240-298-5668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024178957
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR192764
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: