Provider Demographics
NPI:1154027746
Name:ORTIZ, JOHANNY
Entity type:Individual
Prefix:
First Name:JOHANNY
Middle Name:
Last Name:ORTIZ
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 1:4949 TAMIAMI TRL N STE 202
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3017
Mailing Address - Country:US
Mailing Address - Phone:239-591-6592
Mailing Address - Fax:239-692-8264
Practice Address - Street 1:4949 TAMIAMI TRL N STE 202
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3017
Practice Address - Country:US
Practice Address - Phone:239-259-1659
Practice Address - Fax:239-692-8264
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024151363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health