=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447984059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIIA ANNIKKI FORTE APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2022
-----------------------------------------------------
Last Update Date | 08/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4730 SW 49TH RD
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34474-6262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-355-1281
-----------------------------------------------------
Fax | 352-627-4667
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 100294
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32610-0294
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-273-7584
-----------------------------------------------------
Fax | 352-392-9498
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11020705
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------