Provider Demographics
NPI:1598011785
Name:ACOSTA, JESSICA LYNN (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1760 E RIVER RD STE 350
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5999
Mailing Address - Country:US
Mailing Address - Phone:520-519-7700
Mailing Address - Fax:520-519-7910
Practice Address - Street 1:2222 E HIGHLAND AVE STE 400
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4880
Practice Address - Country:US
Practice Address - Phone:602-277-4868
Practice Address - Fax:602-230-9350
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2021-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZF0612491363LF0000X
AZAP4571363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ766637OtherAHCCCS
AZ766637OtherAHCCCS