Provider Demographics
NPI:1285001867
Name:ACOSTA, SHAUNA LEIGH (APRN, CNP)
Entity Type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:LEIGH
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:LEIGH
Other - Last Name:GARDINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:259 E ERIE ST STE 2400
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3907
Mailing Address - Country:US
Mailing Address - Phone:312-695-7269
Mailing Address - Fax:312-695-4924
Practice Address - Street 1:259 E ERIE ST STE 2400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3907
Practice Address - Country:US
Practice Address - Phone:312-695-7269
Practice Address - Fax:312-695-4924
Is Sole Proprietor?:No
Enumeration Date:2015-08-30
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.013135363LW0102X
IL209013135363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health