Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME117974 | FL |
NPI | 1053679647 |
---|---|
Provider Name | Stephanie Ortman |
First Address | Jacksonville Beach, FL 32250-6097 |
Second Address | Jacksonville Beach, FL 32250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2012 |
Last Update Date | 03/08/2018 |