MEDICARE: COLLEEN KOTB ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	RN1006772	DC
2	363LA2200X	Adult Health Nurse Practitioner	0024178731	VA

General Provider Information

NPI Number	:	1821408121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN KOTB ANP

Provider Business Mailing Address
First Line	:	2110 WASHINGTON BLVD STE 350
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-5713
Country	:	US
Telephone Number	:	703-228-5644
Fax Number	:	703-228-5267

Provider Business Practice Location Address
First Line	:	2100 WASHINGTON BLVD FL 2
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-5717
Country	:	US
Telephone Number	:	703-228-5644
Fax Number	:	703-228-5267

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2014
Last Update Date	:	05/23/2022

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