Provider Demographics
NPI:1912915927
Name:ACOSTA, SARAH JANE (MSPA, PA-C)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:JANE
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:MSPA, PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5080 SPECTRUM DR STE 1200W
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4624
Mailing Address - Country:US
Mailing Address - Phone:972-720-7820
Mailing Address - Fax:214-775-4502
Practice Address - Street 1:3007 TOWN CENTER DR STE 100-110
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-3662
Practice Address - Country:US
Practice Address - Phone:910-354-1281
Practice Address - Fax:910-779-2025
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-00367363A00000X
TXPA07226363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1912915927Medicaid
NCQ74799Medicare UPIN
NCNCK696C058Medicare PIN