Provider Demographics
NPI:1225147341
Name:ACOSTA, SEGUNDA YANEZ (PHD, APRN,BC)
Entity Type:Individual
Prefix:DR
First Name:SEGUNDA
Middle Name:YANEZ
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:PHD, APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4436
Mailing Address - Country:US
Mailing Address - Phone:540-373-6420
Mailing Address - Fax:540-373-9026
Practice Address - Street 1:10529 CRESTWOOD DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-4418
Practice Address - Country:US
Practice Address - Phone:703-392-6420
Practice Address - Fax:703-392-6421
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000200364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA145346OtherANTHEM BCBS MANASSAS OFFI
VA5487014OtherAETNA
VA057433OtherANTHEM BCBS FREDERICKSBUR
VAH1670001OtherCARE FIRST
VA324116OtherTRICARE