Provider Demographics
NPI:1023624921
Name:ORTIZ BETANCOURT, KELYI I (FNP)
Entity type:Individual
Prefix:
First Name:KELYI
Middle Name:
Last Name:ORTIZ BETANCOURT
Suffix:I
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5993 W 21ST CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2634
Mailing Address - Country:US
Mailing Address - Phone:305-733-7678
Mailing Address - Fax:
Practice Address - Street 1:702 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-3922
Practice Address - Country:US
Practice Address - Phone:305-265-3239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9476937163WH1000X
FLAPRN11008447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH1000XNursing Service ProvidersRegistered NurseHospice