Healthcare Provider Details

I. General information

NPI: 1982158085
Provider Name (Legal Business Name): TARA ORTIZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 HIOAKS RD STE B
RICHMOND VA
23225-4072
US

IV. Provider business mailing address

671 HIOAKS RD STE B
RICHMOND VA
23225-4072
US

V. Phone/Fax

Practice location:
  • Phone: 804-272-5814
  • Fax: 804-560-0232
Mailing address:
  • Phone: 804-272-5814
  • Fax: 804-560-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024173814
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024173814
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: