Provider Demographics
NPI:1104718469
Name:ORTIZ, JENNA M
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:M
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 1:12500 JUDSON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-4146
Mailing Address - Country:US
Mailing Address - Phone:210-643-6807
Mailing Address - Fax:
Practice Address - Street 1:12500 JUDSON RD STE 300
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-4146
Practice Address - Country:US
Practice Address - Phone:210-967-0096
Practice Address - Fax:210-967-0383
Is Sole Proprietor?:No
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX922029163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine