Healthcare Provider Details

I. General information

NPI: 1205827995
Provider Name (Legal Business Name): KERI H. ORTEGA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD
NAPLES FL
34119-3900
US

IV. Provider business mailing address

PO BOX 551420
FOR LAUDERDALE FL
33607-6307
US

V. Phone/Fax

Practice location:
  • Phone: 239-304-4862
  • Fax: 239-304-5157
Mailing address:
  • Phone: 800-243-3839
  • Fax: 855-851-4405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2932132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: