Provider Demographics
NPI:1346091360
Name:KURPAS, BOTAGOZ (APRN)
Entity Type:Individual
Prefix:MRS
First Name:BOTAGOZ
Middle Name:
Last Name:KURPAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:BOTAGOZ
Other - Middle Name:
Other - Last Name:BASU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:505 W COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2410
Mailing Address - Country:US
Mailing Address - Phone:917-607-6655
Mailing Address - Fax:
Practice Address - Street 1:505 W COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2410
Practice Address - Country:US
Practice Address - Phone:917-607-6655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096925363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology