Provider Demographics
NPI:1386618858
Name:ORTIZ, JOANNA ORTEGA (RN, PA-C)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:ORTEGA
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:RN, PA-C
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:ORTEGA
Other - Last Name:LEUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PA-C
Mailing Address - Street 1:7700 WISCONSIN AVE
Mailing Address - Street 2:7TH FLOOR-FEDERAL OCCUPATIONAL HEALTH MEDICAL EMPLOYABI
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20857
Mailing Address - Country:US
Mailing Address - Phone:757-583-4328
Mailing Address - Fax:
Practice Address - Street 1:7700 WISCONSIN AVE
Practice Address - Street 2:7TH FLOOR-FEDERAL OCCUPATIONAL HEALTH MEDICAL EMPLOYABI
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20857
Practice Address - Country:US
Practice Address - Phone:757-583-4328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001149229163W00000X
GA006095363A00000X
MDC0002889363A00000X
VA0110001370363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA006095OtherPHYSICIAN ASSISTANT
MDC0002889OtherPHYSICIAN ASSISTANT
VA0001149229OtherNURSING
VA0110001370OtherPHYSICIAN ASSISTANT