Provider Demographics
NPI:1912604695
Name:ORTIZ RODRIGUEZ, SORANGEL (APRN)
Entity Type:Individual
Prefix:
First Name:SORANGEL
Middle Name:
Last Name:ORTIZ RODRIGUEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 CLYDE MORRIS BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3199
Mailing Address - Country:US
Mailing Address - Phone:386-615-8971
Mailing Address - Fax:
Practice Address - Street 1:325 CLYDE MORRIS BLVD STE 340
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3199
Practice Address - Country:US
Practice Address - Phone:386-615-8971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024814363L00000X
FLRN9514707163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9514707OtherREGISTERED NURSE
FL11024814OtherFNP LICENSE