MEDICARE: MS. KATHERINE ANN ORTIZ PA-C

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	363AM0700X	Medical Physician Assistant	PA9104398	FL

General Provider Information

NPI Number	:	1952584823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE ANN ORTIZ PA-C

Provider Business Mailing Address
First Line	:	1000 GOODLETTE RD N
Second Line	:	SUITE 100
City	:	NAPLES
State	:	FL
Zip	:	34102-5474
Country	:	US
Telephone Number	:	239-643-2112
Fax Number	:	239-643-0094

Provider Business Practice Location Address
First Line	:	1000 GOODLETTE RD N
Second Line	:	SUITE 100
City	:	NAPLES
State	:	FL
Zip	:	34102-5474
Country	:	US
Telephone Number	:	239-643-2112
Fax Number	:	239-643-0094

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

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	12/13/2007

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