Provider Demographics
NPI:1376208025
Name:ACOSTA, CARMEN CARINA
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:CARINA
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6122 EDSALL RD APT 204
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-5854
Mailing Address - Country:US
Mailing Address - Phone:571-338-6529
Mailing Address - Fax:
Practice Address - Street 1:6122 EDSALL RD APT 204
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-5854
Practice Address - Country:US
Practice Address - Phone:571-338-6529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide