Healthcare Provider Details

I. General information

NPI: 1578350559
Provider Name (Legal Business Name): PATRICIA M ACOSTA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA MERCEDES ACOSTA ALMONTE PATRICIA ACOSTA

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14616 220TH ST
SPRINGFIELD GARDENS NY
11413-3831
US

IV. Provider business mailing address

14616 220TH ST
SPRINGFIELD GARDENS NY
11413-3831
US

V. Phone/Fax

Practice location:
  • Phone: 718-506-8302
  • Fax:
Mailing address:
  • Phone: 718-506-8302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number930558-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number930558-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: