Healthcare Provider Details

I. General information

NPI: 1154161032
Provider Name (Legal Business Name): JESSICA ORTEGON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6542 KENAVA LOOP
PALMETTO FL
34221-2594
US

IV. Provider business mailing address

6542 KENAVA LOOP
PALMETTO FL
34221-2594
US

V. Phone/Fax

Practice location:
  • Phone: 813-895-5026
  • Fax:
Mailing address:
  • Phone: 813-895-5026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: