Provider Demographics
NPI:1013563584
Name:BORGES TORTOLO, NISLIEVY M
Entity Type:Individual
Prefix:
First Name:NISLIEVY
Middle Name:M
Last Name:BORGES TORTOLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12570 SW 7TH CT
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-3457
Mailing Address - Country:US
Mailing Address - Phone:546-104-3509
Mailing Address - Fax:
Practice Address - Street 1:12570 SW 7TH CT
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-3457
Practice Address - Country:US
Practice Address - Phone:546-104-3509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
FL23-292051106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No251E00000XAgenciesHome Health