Provider Demographics
NPI:1932319829
Name:ORTIZ, MARY I (MSN, ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:I
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MSN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7345 REGINA ROYALE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-4545
Mailing Address - Country:US
Mailing Address - Phone:941-545-7034
Mailing Address - Fax:941-925-0215
Practice Address - Street 1:1958 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2217
Practice Address - Country:US
Practice Address - Phone:941-545-7034
Practice Address - Fax:941-925-0215
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1815472363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health