Provider Demographics
NPI:1942480462
Name:ORTIZ, GINA M (RN, NP-C)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08030-1847
Mailing Address - Country:US
Mailing Address - Phone:856-456-1042
Mailing Address - Fax:856-456-8830
Practice Address - Street 1:1017 MARKET ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER CITY
Practice Address - State:NJ
Practice Address - Zip Code:08030-1847
Practice Address - Country:US
Practice Address - Phone:856-456-1042
Practice Address - Fax:856-456-8830
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00143400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily