Provider Demographics
NPI:1588109615
Name:ACOSTA, GLENDA ENEIDA (RN)
Entity type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:ENEIDA
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:RN
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Other - First Name:
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Mailing Address - Street 1:B2 CALLE CONDE
Mailing Address - Street 2:URB PASEOS REALES
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-213-5185
Mailing Address - Fax:787-654-9954
Practice Address - Street 1:1502 CALLE BORI
Practice Address - Street 2:URB ANTONSANTI
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-213-5185
Practice Address - Fax:787-654-9954
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR19213163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1831234301OtherPEDIATRIC HOME CARE