MEDICARE: ANA RIVERA ORTIZ APRN-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	11019239	FL

General Provider Information

NPI Number	:	1285378364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA RIVERA ORTIZ APRN-BC

Provider Business Mailing Address
First Line	:	109 N 32ND AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-7019
Country	:	US
Telephone Number	:	954-655-0341
Fax Number	:

Provider Business Practice Location Address
First Line	:	2466 E COMMERCIAL BLVD STE 101
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4011
Country	:	US
Telephone Number	:	954-655-0341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2022
Last Update Date	:	05/18/2022

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