Provider Demographics
NPI:1083643266
Name:ACOSTA, BARBARA (PA-C)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:DIEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2056 CHAGALL CIR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-7524
Mailing Address - Country:US
Mailing Address - Phone:305-546-4690
Mailing Address - Fax:
Practice Address - Street 1:1760 N CONGRESS AVE STE 200
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426
Practice Address - Country:US
Practice Address - Phone:561-739-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102327363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1475ZMedicare ID - Type Unspecified
FLQ11215Medicare UPIN