Provider Demographics
NPI:1083352249
Name:ACOSTA, LUCILLA MARINO (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:LUCILLA
Middle Name:MARINO
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BARRY LN
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2616
Mailing Address - Country:US
Mailing Address - Phone:860-670-6383
Mailing Address - Fax:860-248-4000
Practice Address - Street 1:14 BARRY LN
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2616
Practice Address - Country:US
Practice Address - Phone:860-670-6383
Practice Address - Fax:860-248-4000
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2355122163WP0200X, 163WS0121X, 163WH0200X
CT144934163WP0200X, 163WH0200X, 163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery