Provider Demographics
NPI:1437302023
Name:ORTIZ, MELISSA TERESE (LPN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:TERESE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 SAINT JAMES RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-6220
Mailing Address - Country:US
Mailing Address - Phone:407-802-2675
Mailing Address - Fax:
Practice Address - Street 1:210 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3560
Practice Address - Country:US
Practice Address - Phone:407-872-7088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN 5175187164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse