Provider Demographics
NPI:1841715737
Name:ORTIZ, CARRIE LOUISE (CNP-C)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LOUISE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:CNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5757
Mailing Address - Country:US
Mailing Address - Phone:216-765-2927
Mailing Address - Fax:216-201-6433
Practice Address - Street 1:4510 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5757
Practice Address - Country:US
Practice Address - Phone:216-765-2927
Practice Address - Fax:216-201-6433
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021426363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily