Healthcare Provider Details

I. General information

NPI: 1932624475
Provider Name (Legal Business Name): ERIN FORTIER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2017
Last Update Date: 12/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 A1A N STE 1
PONTE VEDRA BEACH FL
32082-1773
US

IV. Provider business mailing address

3706 SE 21ST AVE
CAPE CORAL FL
33904-5086
US

V. Phone/Fax

Practice location:
  • Phone: 904-686-8020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: