Healthcare Provider Details

I. General information

NPI: 1417812538
Provider Name (Legal Business Name): JORDAN ALLISON ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 SHALE CIR
BUDA TX
78610-5917
US

IV. Provider business mailing address

338 SHALE CIR
BUDA TX
78610-5917
US

V. Phone/Fax

Practice location:
  • Phone: 512-420-3552
  • Fax:
Mailing address:
  • Phone: 512-420-3552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1080437
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: