Healthcare Provider Details

I. General information

NPI: 1346172913
Provider Name (Legal Business Name): MIGUEL ORTEGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7557 AZALEA COVE CIR
ORLANDO FL
32807-6226
US

IV. Provider business mailing address

7557 AZALEA COVE CIR
ORLANDO FL
32807-6226
US

V. Phone/Fax

Practice location:
  • Phone: 407-470-3645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARPN11047812
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: