Provider Demographics
NPI:1952942393
Name:ORTIZ CALCANO, JUAN CARLOS (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:ORTIZ CALCANO
Suffix:
Gender:M
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13201 ROOSEVELT AVENUE PMB 818149
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5258
Mailing Address - Country:US
Mailing Address - Phone:718-200-8094
Mailing Address - Fax:718-228-3868
Practice Address - Street 1:1218 NEPTUNE AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2903
Practice Address - Country:US
Practice Address - Phone:718-200-8094
Practice Address - Fax:718-228-3868
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028502163W00000X
NY779911163W00000X
MARN2261111163W00000X, 363LF0000X
NY345120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty