Healthcare Provider Details

I. General information

NPI: 1003115890
Provider Name (Legal Business Name): NICOLE MAREE HOTCHKISS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2011
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 LA CALMA DR STE 200
AUSTIN TX
78752-3825
US

IV. Provider business mailing address

6300 LA CALMA DR STE 200
AUSTIN TX
78752-3825
US

V. Phone/Fax

Practice location:
  • Phone: 512-452-8533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberQ4130
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: