Provider Demographics
NPI:1821408121
Name:KOTB, COLLEEN (ANP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:KOTB
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 WASHINGTON BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-5713
Mailing Address - Country:US
Mailing Address - Phone:703-228-5644
Mailing Address - Fax:703-228-5267
Practice Address - Street 1:2100 WASHINGTON BLVD FL 2
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-5717
Practice Address - Country:US
Practice Address - Phone:703-228-5644
Practice Address - Fax:703-228-5267
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1006772363LA2200X
VA0024178731363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health