Healthcare Provider Details

I. General information

NPI: 1790694552
Provider Name (Legal Business Name): BRIGITH NICOLE BAUTISTA ORTIZ BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 JEANETTE LANCASTER WAY
CHARLOTTESVILLE VA
22903-3387
US

IV. Provider business mailing address

3056 HORIZON RD
CHARLOTTESVILLE VA
22902-6615
US

V. Phone/Fax

Practice location:
  • Phone: 434-297-6600
  • Fax:
Mailing address:
  • Phone: 434-409-3742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0001290991
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: