Provider Demographics
NPI:1679596506
Name:COBB, GUDRUN P (NP)
Entity Type:Individual
Prefix:
First Name:GUDRUN
Middle Name:P
Last Name:COBB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 12TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3960
Mailing Address - Country:US
Mailing Address - Phone:512-989-3334
Mailing Address - Fax:512-989-3390
Practice Address - Street 1:103 12TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3960
Practice Address - Country:US
Practice Address - Phone:512-989-3334
Practice Address - Fax:512-989-3390
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX680265363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2902645Medicaid