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General NPI Number Information
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NPI Number | 1982517496
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Entity Type | Individual
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Provider Name | MAYRELYS FORT
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Gender | Female
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Dates
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Enumeration Date | 09/25/2026
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 525 TECHNOLOGY PARK STE 109
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City | LAKE MARY
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State | FL
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Zip | 32746-7107
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Country | US
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Telephone | 321-732-5617
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Fax | 407-708-3941
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Provider Business Mailing Address
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Address Line | 2200 NE 3RD AVE
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City | CAPE CORAL
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State | FL
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Zip | 33909-4219
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Country | US
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Telephone | 786-527-0667
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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 | APRN11051128
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License Number State | FL
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