Provider Demographics
NPI:1578921599
Name:KOTZ, KAREN J (PHD, APRN, NNP-BC)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:J
Last Name:KOTZ
Suffix:
Gender:F
Credentials:PHD, APRN, NNP-BC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:JANE
Other - Last Name:FISHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NNP-BC, APN
Mailing Address - Street 1:3100 SW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:305-666-6511
Mailing Address - Fax:847-723-2338
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:800-432-6837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6804363L00000X
IL209-004682363LF0000X
FL9457886363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100092932Medicaid