Basic Information
Provider Information
NPI: 1679872626
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ORTIZ
FirstName: ANILDA
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 38135 MARKET SQ
Address2:  
City: ZEPHYRHILLS
State: FL
PostalCode: 335427505
CountryCode: US
TelephoneNumber: 8137801255
FaxNumber:  
Practice Location
Address1: 3000 MEDICAL PARK DR STE 150
Address2:  
City: TAMPA
State: FL
PostalCode: 336134679
CountryCode: US
TelephoneNumber: 8139772020
FaxNumber: 8133555010
Other Information
ProviderEnumerationDate: 03/16/2011
LastUpdateDate: 10/05/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XARNP9189191FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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