Provider Demographics
NPI:1497245534
Name:COTTA, KATIE JO (FNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:JO
Last Name:COTTA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:KATIE
Other - Middle Name:JO
Other - Last Name:COTTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RIPKOSKI
Mailing Address - Street 1:1283 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-2274
Mailing Address - Country:US
Mailing Address - Phone:979-299-9394
Mailing Address - Fax:
Practice Address - Street 1:905 N GULF BLVD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:TX
Practice Address - Zip Code:77541-3907
Practice Address - Country:US
Practice Address - Phone:281-824-1480
Practice Address - Fax:281-220-6407
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133803363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner