Provider Demographics
NPI:1497992788
Name:ACOSTA, EUGENE L (CRNA)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:L
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8423 ALYSSA GARDENS LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-3772
Mailing Address - Country:US
Mailing Address - Phone:281-883-3250
Mailing Address - Fax:
Practice Address - Street 1:8423 ALYSSA GARDENS LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-3772
Practice Address - Country:US
Practice Address - Phone:281-883-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX702690367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered