Provider Demographics
NPI:1609253848
Name:ACOSTA, XIMENA (PA)
Entity type:Individual
Prefix:
First Name:XIMENA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 W PARKER RD STE 306
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7934
Mailing Address - Country:US
Mailing Address - Phone:972-981-7135
Mailing Address - Fax:972-981-7136
Practice Address - Street 1:6130 W PARKER RD STE 306
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7934
Practice Address - Country:US
Practice Address - Phone:972-981-7135
Practice Address - Fax:972-981-7136
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08453363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX409529YKP5Medicare PIN