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General NPI Number Information
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NPI Number | 1972478402
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Entity Type | Organization
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Legal Business Name | COCO FUNCTIONAL WELLNESS
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 248 ADDIE ROY RD # A103
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City | AUSTIN
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State | TX
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Zip | 78746-4131
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Country | US
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Telephone | 737-412-1833
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Fax |
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Provider Business Mailing Address
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Address Line | 248 ADDIE ROY RD # A103
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City | AUSTIN
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State | TX
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Zip | 78746-4131
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Country | US
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Telephone | 737-412-1833
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Fax |
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Authorized Official
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Title or Position | FNP-C
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Name | BRANDI NICHOLE WOLF
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Credential | FNP-C
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Telephone | 737-412-1833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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