Provider Demographics
NPI:1093474470
Name:ORTEA, ELIZABETH LOURDES (APRN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LOURDES
Last Name:ORTEA
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 1:3025 W SIGNATURE DR APT 507
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-6464
Mailing Address - Country:US
Mailing Address - Phone:954-401-1152
Mailing Address - Fax:
Practice Address - Street 1:806 S DOUGLAS RD STE 625
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3157
Practice Address - Country:US
Practice Address - Phone:786-743-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010098363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily