Healthcare Provider Details

I. General information

NPI: 1720512940
Provider Name (Legal Business Name): DANIELLE-MARVIS FORTINGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7521 GUADALUPE WAY
MCKINNEY TX
75071-3389
US

IV. Provider business mailing address

7521 GUADALUPE WAY
MCKINNEY TX
75071-3389
US

V. Phone/Fax

Practice location:
  • Phone: 469-634-6690
  • Fax:
Mailing address:
  • Phone: 404-457-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP134233
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: