Healthcare Provider Details

I. General information

NPI: 1558063750
Provider Name (Legal Business Name): ANDRES RICARDO TORTOLERO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MICCOSUKEE RD
TALLAHASSEE FL
32308-5054
US

IV. Provider business mailing address

1300 MICCOSUKEE RD
TALLAHASSEE FL
32308-5054
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-1155
  • Fax:
Mailing address:
  • Phone: 850-431-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS23684
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS23684
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: