Provider Demographics
NPI:1508423070
Name:ORTIZ-RIVERA, LISA MARIE
Entity Type:Individual
Prefix:
First Name:LISA MARIE
Middle Name:
Last Name:ORTIZ-RIVERA
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 1:15150 PIPING PLOVER CT 103
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917
Mailing Address - Country:US
Mailing Address - Phone:239-810-3458
Mailing Address - Fax:
Practice Address - Street 1:15150 PIPING PLOVER CT 103
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917
Practice Address - Country:US
Practice Address - Phone:239-810-3458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9354288163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse