Healthcare Provider Details

I. General information

NPI: 1821408121
Provider Name (Legal Business Name): COLLEEN KOTB ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 05/23/2022
Certification Date: 05/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WASHINGTON BLVD FL 2
ARLINGTON VA
22204-5717
US

IV. Provider business mailing address

2110 WASHINGTON BLVD STE 350
ARLINGTON VA
22204-5713
US

V. Phone/Fax

Practice location:
  • Phone: 703-228-5644
  • Fax: 703-228-5267
Mailing address:
  • Phone: 703-228-5644
  • Fax: 703-228-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN1006772
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024178731
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: