Provider Demographics
NPI:1447079546
Name:ACOSTA, AMANDA (APRN, CNM, WHNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:APRN, CNM, WHNP-BC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:SANTILLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2576 BIBURY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-5003
Mailing Address - Country:US
Mailing Address - Phone:815-505-3263
Mailing Address - Fax:
Practice Address - Street 1:2909 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-3100
Practice Address - Country:US
Practice Address - Phone:779-696-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367A00000X
IL209.030377363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife