Healthcare Provider Details

I. General information

NPI: 1053685420
Provider Name (Legal Business Name): DARLENE FORTUNE DNP, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 MADRUGA AVE SUITE 406
CORAL GABLES FL
33146-3148
US

IV. Provider business mailing address

1450 MADRUGA AVE SUITE 406
CORAL GABLES FL
33146-3148
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-8899
  • Fax:
Mailing address:
  • Phone: 305-666-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP1054872
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: