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Individual

MRS. JENNIFER ACOSTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
4818 S TUJUNGA DR, SPRINGFIELD, MO 65810-1125
(785) 250-7910
Mailing address
4818 S TUJUNGA DR, SPRINGFIELD, MO 65810-1125

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2016023555
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
220033618
MO
Enumeration date
05/22/2007
Last updated
10/19/2023
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