Healthcare Provider Details

I. General information

NPI: 1457702482
Provider Name (Legal Business Name): CARLOS GILBERTO ORTIZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S GOLDENROD RD STE B
ORLANDO FL
32822-8113
US

IV. Provider business mailing address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 407-362-0148
  • Fax: 833-450-5409
Mailing address:
  • Phone: 407-362-0148
  • Fax: 689-304-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9303952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: