Healthcare Provider Details

I. General information

NPI: 1356040125
Provider Name (Legal Business Name): GERALDINE ORTIZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 OAKLEY SEAVER DR STE 206
CLERMONT FL
34711-1950
US

IV. Provider business mailing address

6552 1ST AVE S
ST PETERSBURG FL
33707-1304
US

V. Phone/Fax

Practice location:
  • Phone: 352-234-8815
  • Fax:
Mailing address:
  • Phone: 813-732-7096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number9477949
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11024877
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11024877
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: