Healthcare Provider Details

I. General information

NPI: 1790326858
Provider Name (Legal Business Name): NICOLE ACOSTA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E CLINTON ST
HOBBS NM
88240-8238
US

IV. Provider business mailing address

315 E CLINTON ST
HOBBS NM
88240-8238
US

V. Phone/Fax

Practice location:
  • Phone: 575-393-0755
  • Fax:
Mailing address:
  • Phone: 575-393-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN-76112
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: