Provider Demographics
NPI:1508104241
Name:COTTLE, DAVID L JR (CRNA)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:COTTLE
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 ALMOFINI LN
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-6316
Mailing Address - Country:US
Mailing Address - Phone:361-960-1581
Mailing Address - Fax:
Practice Address - Street 1:148 ALMOFINI LN
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-6316
Practice Address - Country:US
Practice Address - Phone:361-960-1581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27578367500000X
TX731071163W00000X
TXAP123269367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse