Healthcare Provider Details

I. General information

NPI: 1205754413
Provider Name (Legal Business Name): JESSICA M ACOSTA SUAREZ
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

B41 ATENAS CALLE ELLIOT VELEZ
MANATI PR
00674-9525
US

IV. Provider business mailing address

PO BOX 849
MANATI PR
00674-0849
US

V. Phone/Fax

Practice location:
  • Phone: 787-621-4364
  • Fax:
Mailing address:
  • Phone: 787-621-4364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001218-P.A.
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: