Healthcare Provider Details

I. General information

NPI: 1619820990
Provider Name (Legal Business Name): SARAH FORTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W NORTH AVE
WEST CHICAGO IL
60185-6224
US

IV. Provider business mailing address

4832 WEAVER ST
OSWEGO IL
60543-8180
US

V. Phone/Fax

Practice location:
  • Phone: 727-366-8810
  • Fax:
Mailing address:
  • Phone: 727-366-8810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.035139
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: