Provider Demographics
NPI:1124505607
Name:ORTIZ, SHOVAN (APRN)
Entity type:Individual
Prefix:MRS
First Name:SHOVAN
Middle Name:
Last Name:ORTIZ
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 1:1966 NEWARK LN
Mailing Address - Street 2:
Mailing Address - City:THOMPSONS STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37179-9660
Mailing Address - Country:US
Mailing Address - Phone:615-589-2753
Mailing Address - Fax:
Practice Address - Street 1:3054 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064
Practice Address - Country:US
Practice Address - Phone:615-550-0091
Practice Address - Fax:615-550-1397
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24488207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily