Provider Demographics
NPI:1679872626
Name:ORTIZ, ANILDA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ANILDA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:ARNP
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:813-780-1255
Mailing Address - Fax:
Practice Address - Street 1:3000 MEDICAL PARK DR STE 150
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4679
Practice Address - Country:US
Practice Address - Phone:813-977-2020
Practice Address - Fax:813-355-5010
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9189191363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFK825YMedicare PIN