Healthcare Provider Details

I. General information

NPI: 1417838566
Provider Name (Legal Business Name): TIFFANY ACOSTA AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 POST RD STE 203
WESTERLY RI
02891-6601
US

IV. Provider business mailing address

PO BOX 229
WAKEFIELD RI
02880-0229
US

V. Phone/Fax

Practice location:
  • Phone: 401-604-2530
  • Fax: 401-604-2560
Mailing address:
  • Phone: 401-788-3929
  • Fax: 401-788-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN53546
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: