Provider Demographics
NPI:1114727856
Name:ORTIZ, KAYLA (APNP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8632 N 52ND ST
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-3051
Mailing Address - Country:US
Mailing Address - Phone:850-781-2096
Mailing Address - Fax:
Practice Address - Street 1:525 W RIVER WOODS PKWY STE 130
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1010
Practice Address - Country:US
Practice Address - Phone:414-961-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16462-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily