Provider Demographics
NPI:1508095175
Name:LERMONT-ORTIZ, MEXTLI (PA-C)
Entity Type:Individual
Prefix:
First Name:MEXTLI
Middle Name:
Last Name:LERMONT-ORTIZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-528-4975
Mailing Address - Fax:813-355-5084
Practice Address - Street 1:6101 WEBB RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2872
Practice Address - Country:US
Practice Address - Phone:813-888-8887
Practice Address - Fax:813-249-2622
Is Sole Proprietor?:No
Enumeration Date:2009-07-04
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105035363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9105035OtherMEDICAL LICENSE
FLPA9105035OtherMEDICAL LICENSE
FLCA268U-TPAMedicare PIN