MEDICARE: DR. MANDY COTTEN FNP-C, P.A.

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1962974550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MANDY COTTEN FNP-C, P.A.

Provider Business Mailing Address
First Line	:	4224 PARK SPRINGS BLVD STE 100
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-4729
Country	:	US
Telephone Number	:	817-467-7474
Fax Number	:	817-468-8643

Provider Business Practice Location Address
First Line	:	4224 PARK SPRINGS BLVD STE 100
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-4729
Country	:	US
Telephone Number	:	817-467-7474
Fax Number	:	817-468-8643

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MANDY BETH COTTEN
Credential	:	FNP-C
Telephone Number	:	817-467-7474

Provider Enumeration Date	:	12/20/2018
Last Update Date	:	08/28/2020

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