Provider Demographics
NPI:1619630357
Name:ACOSTA, JEANETTE
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
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 1:15020 WAYNE LEE CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-8245
Mailing Address - Country:US
Mailing Address - Phone:661-910-4013
Mailing Address - Fax:
Practice Address - Street 1:13646 CA-33
Practice Address - Street 2:
Practice Address - City:LOST HILLS
Practice Address - State:CA
Practice Address - Zip Code:93249
Practice Address - Country:US
Practice Address - Phone:661-797-6607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021241363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner