Provider Demographics
NPI:1366846719
Name:ORREGO, MARIA XIMENA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:XIMENA
Last Name:ORREGO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:XIMENA
Other - Last Name:ORREGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-561-5050
Mailing Address - Fax:239-343-4241
Practice Address - Street 1:12801 WESTLINKS DR STE 103
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8001
Practice Address - Country:US
Practice Address - Phone:239-561-5050
Practice Address - Fax:239-343-4241
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119565100Medicaid