MEDICARE: MERYL MARIE ORTIZ FNP-C

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	363LF0000X	Family Nurse Practitioner	254410	AZ

General Provider Information

NPI Number	:	1376112672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERYL MARIE ORTIZ FNP-C

Provider Business Mailing Address
First Line	:	6567 E CARONDELET DR STE 515
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-6158
Country	:	US
Telephone Number	:	520-885-1402
Fax Number	:	520-722-5887

Provider Business Practice Location Address
First Line	:	6567 E CARONDELET DR STE 515
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-6158
Country	:	US
Telephone Number	:	520-885-1402
Fax Number	:	520-722-5887

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

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	06/21/2021

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