=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154208932
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WHITNEY PORTILLO FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2025
-----------------------------------------------------
Last Update Date | 08/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2713 W EAU GALLIE BLVD
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32935-8922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-340-6005
-----------------------------------------------------
Fax | 321-241-3073
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 588 BURLINGTON AVE NE
-----------------------------------------------------
City | PALM BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32907-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-477-8926
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 11041107
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 11041107
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------