Provider Demographics
NPI:1437424983
Name:ACOSTA, PABLO C (NP)
Entity Type:Individual
Prefix:MR
First Name:PABLO
Middle Name:C
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 E RIVULON BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0087
Mailing Address - Country:US
Mailing Address - Phone:480-494-2465
Mailing Address - Fax:480-534-4087
Practice Address - Street 1:16113 W CORONADO RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7130
Practice Address - Country:US
Practice Address - Phone:623-695-0449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN110209163W00000X
AZAP7817363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse