Provider Demographics
NPI:1306442652
Name:ACOSTA, JATNNA F
Entity type:Individual
Prefix:
First Name:JATNNA
Middle Name:F
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 1:120 E 36TH ST STE 1E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3423
Mailing Address - Country:US
Mailing Address - Phone:212-888-2222
Mailing Address - Fax:212-532-9999
Practice Address - Street 1:120 E 36TH ST STE 1E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3423
Practice Address - Country:US
Practice Address - Phone:212-888-2222
Practice Address - Fax:212-532-9999
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator