Provider Demographics
NPI:1508196999
Name:ACOSTA, STEPHANIE MYREL (APRN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MYREL
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USCG SECTOR SAN JUAN #5 CALLE LA PUNTILLA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-1800
Mailing Address - Country:US
Mailing Address - Phone:787-729-2305
Mailing Address - Fax:787-289-7991
Practice Address - Street 1:9 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:ULM
Practice Address - State:MT
Practice Address - Zip Code:59485
Practice Address - Country:US
Practice Address - Phone:928-660-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-234817363L00000X, 163W00000X
OR202209765RN163WC0200X
CA95185761163WC0200X
MI4704413416363L00000X, 163W00000X
MN2523379163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163W00000XNursing Service ProvidersRegistered Nurse