Healthcare Provider Details

I. General information

NPI: 1700385234
Provider Name (Legal Business Name): MISAIL DE LA TORRE ORTEGA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2018
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 NW 18TH PL
CAPE CORAL FL
33993-7608
US

IV. Provider business mailing address

23 NW 18TH PL
CAPE CORAL FL
33993-7608
US

V. Phone/Fax

Practice location:
  • Phone: 786-403-2433
  • Fax:
Mailing address:
  • Phone: 786-403-2433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11047220
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: