Healthcare Provider Details

I. General information

NPI: 1538004429
Provider Name (Legal Business Name): ERICKA ORTIZ BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 OLD KINGS RD S STE 4
FLAGLER BEACH FL
32136-4356
US

IV. Provider business mailing address

309 LAKE GERTIE RD
DELAND FL
32720
US

V. Phone/Fax

Practice location:
  • Phone: 386-623-1644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN9539041
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: