Healthcare Provider Details

I. General information

NPI: 1720759269
Provider Name (Legal Business Name): CHLOE JAYNE FORTNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHLOE JAYNE BROWN

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6037 WINTHROP COMMERCE AVE STE 210
RIVERVIEW FL
33578-4694
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 813-423-7123
  • Fax: 813-423-7124
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113927
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: