Healthcare Provider Details

I. General information

NPI: 1124461595
Provider Name (Legal Business Name): TARA MELISSA ORTIZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

670 NE 118TH ST
BISCAYNE PARK FL
33161-6207
US

V. Phone/Fax

Practice location:
  • Phone: 305-324-3176
  • Fax:
Mailing address:
  • Phone: 954-295-0570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9234896
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number92501
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: