MEDICARE: SARAH MARIA FORTIN PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	17729	OH

General Provider Information

NPI Number	:	1841674215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH MARIA FORTIN PMHNP-BC

Provider Business Mailing Address
First Line	:	868 FRANKLIN AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-1138
Country	:	US
Telephone Number	:	608-381-0350
Fax Number	:

Provider Business Practice Location Address
First Line	:	67 E WATER ST
Second Line	:
City	:	CHILLICOTHEE
State	:	OH
Zip	:	45601-2535
Country	:	US
Telephone Number	:	614-304-1591
Fax Number	:

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

Provider Enumeration Date	:	07/16/2015
Last Update Date	:	11/17/2025

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