Provider Demographics
NPI:1114694510
Name:RODRIGUEZ ACOSTA, CARMELA ESPERANZA (FNP)
Entity Type:Individual
Prefix:
First Name:CARMELA
Middle Name:ESPERANZA
Last Name:RODRIGUEZ ACOSTA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8225 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77061-1201
Mailing Address - Country:US
Mailing Address - Phone:713-469-4735
Mailing Address - Fax:713-469-4740
Practice Address - Street 1:8225 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77061-1201
Practice Address - Country:US
Practice Address - Phone:713-469-4735
Practice Address - Fax:713-469-4740
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR553864484OtherPASSPORT