Provider Demographics
NPI:1952944258
Name:COTA, CARLI JADE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:CARLI
Middle Name:JADE
Last Name:COTA
Suffix:
Gender:F
Credentials:AGACNP-BC
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:MAILCODE SJH-2
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-4910
Mailing Address - Fax:503-494-8368
Practice Address - Street 1:6411 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-6713
Practice Address - Fax:713-500-6528
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2024-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXAP143289363LA2100X
OR201909209NP-PP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care