Healthcare Provider Details

I. General information

NPI: 1154245686
Provider Name (Legal Business Name): AMANDA DEWATI ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 VISTA PKWY STE 400
WEST PALM BEACH FL
33411-6742
US

IV. Provider business mailing address

2054 VISTA PKWY STE 400
WEST PALM BEACH FL
33411-6742
US

V. Phone/Fax

Practice location:
  • Phone: 727-213-3459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11048427
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: