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General NPI Number Information
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NPI Number | 1568114395
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Entity Type | Individual
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Provider Name | FLAVIA LORENA ORTIZ
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Gender | Female
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 5005 PORT ST JOHN PKWY
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City | PORT ST JOHN
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State | FL
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Zip | 32927-4305
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Country | US
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Telephone | 321-633-8620
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Fax |
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Provider Business Mailing Address
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Address Line | 603 ANDERSON DR
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City | DELTONA
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State | FL
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Zip | 32725-8165
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Country | US
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Telephone | 407-731-1094
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11017588
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License Number State | FL
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