Healthcare Provider Details

I. General information

NPI: 1568927200
Provider Name (Legal Business Name): ALISHA OTTATI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W HIGHWAY 436
ALTAMONTE SPRINGS FL
32714-4136
US

IV. Provider business mailing address

860 N ORANGE AVE APT 326
ORLANDO FL
32801-1056
US

V. Phone/Fax

Practice location:
  • Phone: 407-200-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9355187
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9355187
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: