Healthcare Provider Details

I. General information

NPI: 1013350636
Provider Name (Legal Business Name): FERNANDO ORTIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 NW 8TH AVE
GAINESVILLE FL
32605-4687
US

IV. Provider business mailing address

4645 NW 8TH AVE
GAINESVILLE FL
32605-4687
US

V. Phone/Fax

Practice location:
  • Phone: 352-375-1212
  • Fax: 352-371-4650
Mailing address:
  • Phone: 352-375-1212
  • Fax: 352-371-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2019-01389
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2019-01389
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME150450
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: