Healthcare Provider Details

I. General information

NPI: 1710804281
Provider Name (Legal Business Name): SANDRA PATRICIA ORTEGA NEMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3647 VICTORIA MANOR DR APT 205
LAKELAND FL
33805-2984
US

IV. Provider business mailing address

3647 VICTORIA MANOR DR APT 205
LAKELAND FL
33805-2984
US

V. Phone/Fax

Practice location:
  • Phone: 863-738-2154
  • Fax:
Mailing address:
  • Phone: 863-738-2154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberO228560704000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: