Provider Demographics
NPI:1699567891
Name:ACOSTA, BRIGITTE NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:NICOLE
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRIGITTE
Other - Middle Name:NICOLE
Other - Last Name:DWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 SCHORN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-3674
Mailing Address - Country:US
Mailing Address - Phone:734-751-7960
Mailing Address - Fax:
Practice Address - Street 1:36 SCHORN DR
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-3674
Practice Address - Country:US
Practice Address - Phone:734-751-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant