MEDICARE: CHANTEL NICOLE ORTIZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1033896162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANTEL NICOLE ORTIZ

Provider Business Mailing Address
First Line	:	11805 CASTINE ST
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-1806
Country	:	US
Telephone Number	:	813-593-9536
Fax Number	:

Provider Business Practice Location Address
First Line	:	11805 CASTINE ST
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-1806
Country	:	US
Telephone Number	:	813-593-9536
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2023
Last Update Date	:	06/30/2023

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Directions to “ CHANTEL NICOLE ORTIZ ” Practice Location

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