Provider Demographics
NPI:1427642537
Name:ORTIZ, ANISA J (NP)
Entity type:Individual
Prefix:MISS
First Name:ANISA
Middle Name:J
Last Name:ORTIZ
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 MEREDITH PL
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2258
Mailing Address - Country:US
Mailing Address - Phone:267-455-9230
Mailing Address - Fax:
Practice Address - Street 1:2625 W GIRARD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-1333
Practice Address - Country:US
Practice Address - Phone:267-455-9230
Practice Address - Fax:215-358-1041
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023317363LA2200X, 363LG0600X
NJ26NJ01143200363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMS6456479OtherDEA NJ