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General NPI Number Information
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NPI Number | 1477458644
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Entity Type | Organization
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Legal Business Name | ACOSTA FAMILY CLINIC
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Dates
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Enumeration Date | 10/08/2026
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Last Update Date | 10/08/2026
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Provider Practice Location Address
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Address Line | 6021 WASHINGTON ST
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City | GURNEE
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State | IL
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Zip | 60031-5356
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Country | US
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Telephone | 847-371-1615
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Fax |
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Provider Business Mailing Address
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Address Line | 12594 W MAWMAN AVE
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City | BEACH PARK
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State | IL
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Zip | 60087-2027
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FNP/OWNER
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Name | DAISY ACOSTA
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Credential | APRN
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Telephone | 847-371-1615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | NULL
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