Healthcare Provider Details

I. General information

NPI: 1932754314
Provider Name (Legal Business Name): TERCILIA LAFORTUNE FNP, SINLGE PROVIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 6TH ST S
ST PETERSBURG FL
33701-4814
US

IV. Provider business mailing address

6226 45TH LN E
BRADENTON FL
34203-0005
US

V. Phone/Fax

Practice location:
  • Phone: 727-823-1234
  • Fax:
Mailing address:
  • Phone: 239-464-7714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAPRN11003379
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberAPRN11003379
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11003379
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: