Healthcare Provider Details

I. General information

NPI: 1982517496
Provider Name (Legal Business Name): MAYRELYS FORT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAYRELYS GARCIA MARTINEZ

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 TECHNOLOGY PARK STE 109
LAKE MARY FL
32746-7107
US

IV. Provider business mailing address

2200 NE 3RD AVE
CAPE CORAL FL
33909-4219
US

V. Phone/Fax

Practice location:
  • Phone: 321-732-5617
  • Fax: 407-708-3941
Mailing address:
  • Phone: 786-527-0667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11051128
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: