Healthcare Provider Details

I. General information

NPI: 1215393970
Provider Name (Legal Business Name): IVONN MARCELA ORTEGA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3346 US HIGHWAY 19
HOLIDAY FL
34691-1846
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 600
NASHVILLE TN
37205-5250
US

V. Phone/Fax

Practice location:
  • Phone: 727-615-6702
  • Fax: 727-615-2196
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9267313
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: