Healthcare Provider Details

I. General information

NPI: 1740077890
Provider Name (Legal Business Name): GLADYS MAGDALENA OTTENWALDER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 LITTLE RD
NEW PORT RICHEY FL
34654-4924
US

IV. Provider business mailing address

8501 LITTLE RD
NEW PORT RICHEY FL
34654-4924
US

V. Phone/Fax

Practice location:
  • Phone: 727-869-7755
  • Fax: 727-869-7372
Mailing address:
  • Phone: 727-869-7755
  • Fax: 727-869-7372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF03250639
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: