Provider Demographics
NPI:1114312576
Name:KOTZ, BRANDY (FNP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:KOTZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-2100
Mailing Address - Country:US
Mailing Address - Phone:409-719-8895
Mailing Address - Fax:
Practice Address - Street 1:3600 GATES BLVD
Practice Address - Street 2:EMERGENCY ROOM
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-3858
Practice Address - Country:US
Practice Address - Phone:409-989-5124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily