Healthcare Provider Details

I. General information

NPI: 1952584823
Provider Name (Legal Business Name): KATHERINE ANN ORTIZ I-MD, PH.D., PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26800 S TAMIAMI TRL STE 380
BONITA SPRINGS FL
34134-4355
US

IV. Provider business mailing address

26800 S TAMIAMI TRL STE 380
BONITA SPRINGS FL
34134-4355
US

V. Phone/Fax

Practice location:
  • Phone: 239-250-7930
  • Fax: 888-353-4429
Mailing address:
  • Phone: 239-250-7930
  • Fax: 888-353-4429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9104398
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberPA9104398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: