Healthcare Provider Details

I. General information

NPI: 1841674215
Provider Name (Legal Business Name): SARAH MARIA FORTIN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 E BROAD ST STE 112
COLUMBUS OH
43205-1378
US

IV. Provider business mailing address

868 FRANKLIN AVE
COLUMBUS OH
43205-1138
US

V. Phone/Fax

Practice location:
  • Phone: 614-285-6562
  • Fax: 608-387-8005
Mailing address:
  • Phone: 614-285-6562
  • Fax: 608-387-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number17729
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: