Provider Demographics
NPI:1821626193
Name:ACOSTA, CHRISTY (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45814 MOUNTAIN PINE SQ
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-7216
Mailing Address - Country:US
Mailing Address - Phone:757-480-1979
Mailing Address - Fax:
Practice Address - Street 1:45814 MOUNTAIN PINE SQ
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-7216
Practice Address - Country:US
Practice Address - Phone:757-480-1979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001203977163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse