Provider Demographics
NPI:1235327792
Name:FOX, CHARLOTTE SUZANNE (RN, MSN, ACNP-BC)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:SUZANNE
Last Name:FOX
Suffix:
Gender:F
Credentials:RN, MSN, ACNP-BC
Other - Prefix:
Other - First Name:CHARLIE
Other - Middle Name:FOX
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 COUNTY ROAD 340A
Mailing Address - Street 2:BLDG 1 SUITE B
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-4537
Mailing Address - Country:US
Mailing Address - Phone:512-715-3032
Mailing Address - Fax:512-715-3029
Practice Address - Street 1:200 COUNTY ROAD 340A
Practice Address - Street 2:BLDG. 1, STE. B
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-4537
Practice Address - Country:US
Practice Address - Phone:512-715-3032
Practice Address - Fax:512-715-3029
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX606313363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194024905Medicaid
TX194024907Medicaid
TX194024908Medicaid
TX8100NMOtherBCBS
TX194024907Medicaid
TX194024908Medicaid