Provider Demographics
NPI:1306725650
Name:ORTEGA SUAREZ, JOSE A SR
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:ORTEGA SUAREZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 MERRIMACK DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-7914
Mailing Address - Country:US
Mailing Address - Phone:786-817-4708
Mailing Address - Fax:
Practice Address - Street 1:2303 MERRIMACK DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-7914
Practice Address - Country:US
Practice Address - Phone:786-817-4708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-30
Last Update Date:2025-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily