Provider Demographics
NPI:1245230259
Name:GONZALEZ-ORTIZ, EVELYN (MD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:
Last Name:GONZALEZ-ORTIZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:1111 NE 25TH AVE STE 301
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-5667
Practice Address - Country:US
Practice Address - Phone:352-351-7000
Practice Address - Fax:352-236-8610
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9757173000000X, 208D00000X
FLACN703208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLII292ZMedicare PIN
FLII292ZMedicare PIN