Provider Demographics
NPI:1760216642
Name:ORTEGA, ANGEL FIDEL (APRN)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:FIDEL
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19231 NW 39TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2216
Mailing Address - Country:US
Mailing Address - Phone:305-322-6242
Mailing Address - Fax:
Practice Address - Street 1:19231 NW 39TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2216
Practice Address - Country:US
Practice Address - Phone:305-322-6242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-31
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11032671363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily