Healthcare Provider Details

I. General information

NPI: 1982242566
Provider Name (Legal Business Name): ERVING ORTIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2019
Last Update Date: 12/14/2019
Certification Date: 12/14/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BURNSED BLVD
THE VILLAGES FL
32163-2704
US

IV. Provider business mailing address

1010 N HORSE PRAIRIE RD
INVERNESS FL
34450-1885
US

V. Phone/Fax

Practice location:
  • Phone: 352-753-7476
  • Fax: 352-753-5372
Mailing address:
  • Phone: 352-344-9265
  • Fax: 352-753-5372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPS33847
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: