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General NPI Number Information
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NPI Number | 1205494580
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Entity Type | Individual
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Provider Name | TANDI W. FORTIER NP
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Gender | Female
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Dates
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Enumeration Date | 06/03/2019
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 41 PARK CREEK DR
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City | GREENVILLE
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State | SC
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Zip | 29605-4270
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Country | US
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Telephone | 864-299-1600
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Fax | 864-422-2964
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Provider Business Mailing Address
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Address Line | 412 MIDDLESHARE DR
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City | MAULDIN
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State | SC
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Zip | 29662-3312
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Country | US
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Telephone | 864-567-9086
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 22821
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License Number State | SC
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