Provider Demographics
NPI:1194024703
Name:ACOSTA, JUDY-ANN MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JUDY-ANN
Middle Name:MARIE
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MEDICAL CENTER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3163
Mailing Address - Country:US
Mailing Address - Phone:936-632-4282
Mailing Address - Fax:936-462-4249
Practice Address - Street 1:10 MEDICAL CENTER BLVD STE A
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3163
Practice Address - Country:US
Practice Address - Phone:936-632-4282
Practice Address - Fax:936-462-4249
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07160363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical