=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790469823
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIFFANY ORTIZ FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2023
-----------------------------------------------------
Last Update Date | 03/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6501 4TH ST NW STE D
-----------------------------------------------------
City | LOS RANCHOS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87107-5800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-431-0412
-----------------------------------------------------
Fax | 505-214-5872
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6501 4TH ST NW STE D
-----------------------------------------------------
City | LOS RANCHOS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87107-5800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-431-0412
-----------------------------------------------------
Fax | 505-214-5872
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | N-89561
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 73995
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------