Provider Demographics
NPI:1386622660
Name:ACOSTA, BELINDA JAQUEZ (FNP)
Entity type:Individual
Prefix:MS
First Name:BELINDA
Middle Name:JAQUEZ
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5055 E BROADWAY BLVD
Mailing Address - Street 2:A100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3640
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:1400 W VALENCIA RD
Practice Address - Street 2:STE110
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-6003
Practice Address - Country:US
Practice Address - Phone:520-751-3335
Practice Address - Fax:520-751-3312
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZRN035539363L00000X
AZAP0863363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP24872Medicare UPIN
AZ270721Medicare ID - Type Unspecified