Healthcare Provider Details

I. General information

NPI: 1134332612
Provider Name (Legal Business Name): DEBBIE SUE FORTNEY RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5238 MASON CORBIN COURT SUITE 101
FORT MYERS FL
33907-7738
US

IV. Provider business mailing address

8440 REDWOOD DR
ST JAMES CITY FL
33956-2913
US

V. Phone/Fax

Practice location:
  • Phone: 239-936-9700
  • Fax: 239-936-9707
Mailing address:
  • Phone: 913-481-4441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN9201519
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: