Provider Demographics
NPI:1104594969
Name:ORTA, ANA MARIA
Entity type:Individual
Prefix:
First Name:ANA MARIA
Middle Name:
Last Name:ORTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4006 LONGNEEDLE LN APT 120
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5250
Mailing Address - Country:US
Mailing Address - Phone:321-339-6214
Mailing Address - Fax:
Practice Address - Street 1:4006 LONGNEEDLE LN APT 120
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5250
Practice Address - Country:US
Practice Address - Phone:321-339-6214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-05
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL21000385993343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL21000385993OtherNON EMERGENCY