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: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 W SWANN AVE STE 100
TAMPA FL
33609-4039
US

IV. Provider business mailing address

2675 WINKLER AVE STE 200
FORT MYERS FL
33901-9328
US

V. Phone/Fax

Practice location:
  • Phone: 813-874-5500
  • Fax: 813-874-5505
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: