Provider Demographics
NPI:1215675616
Name:ORTIZ, CRYSTAL (FNP-C)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2142
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540-2142
Mailing Address - Country:US
Mailing Address - Phone:956-483-7555
Mailing Address - Fax:
Practice Address - Street 1:801 S MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5056
Practice Address - Country:US
Practice Address - Phone:956-686-0574
Practice Address - Fax:956-686-3301
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF504220482363LF0000X
TX1077041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily