Provider Demographics
NPI:1043676679
Name:ACOSTA, RENE LEE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:RENE
Middle Name:LEE
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-2136
Mailing Address - Country:US
Mailing Address - Phone:956-536-7363
Mailing Address - Fax:
Practice Address - Street 1:3202 TUCKER RD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-2136
Practice Address - Country:US
Practice Address - Phone:956-536-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129973367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered