MEDICARE: SARAH FORTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209.035139	IL

General Provider Information

NPI Number	:	1619820990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH FORTIN

Provider Business Mailing Address
First Line	:	4832 WEAVER ST
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-8180
Country	:	US
Telephone Number	:	727-366-8810
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 W NORTH AVE
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-6224
Country	:	US
Telephone Number	:	727-366-8810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	05/01/2026

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