Provider Demographics
NPI:1740019371
Name:ORTIZ DE JESUS, ALONDRA (PA-C)
Entity type:Individual
Prefix:
First Name:ALONDRA
Middle Name:
Last Name:ORTIZ DE JESUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 SOUTHERLY PARC LN APT 7109
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8071
Mailing Address - Country:US
Mailing Address - Phone:786-266-8850
Mailing Address - Fax:
Practice Address - Street 1:1200 DELTONA BLVD APT 40A
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-6386
Practice Address - Country:US
Practice Address - Phone:386-202-6025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9119050363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical