Provider Demographics
NPI:1821854787
Name:ORTIZ, ELISABETH GAYLE (APRN)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:GAYLE
Last Name:ORTIZ
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:
Other - Last Name:JENNETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29208-4001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 W PRINCETON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5214
Practice Address - Country:US
Practice Address - Phone:407-553-8587
Practice Address - Fax:407-537-2063
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11034456363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health