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NPI Code Detail

MEDICARE: MS. MELANIE STOVALL FORTENBERRY FNP

MEDICARE: MS. MELANIE STOVALL FORTENBERRY FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN9595541FL
2363LF0000XFamily Nurse PractitionerRN164301GA
3363LF0000XFamily Nurse PractitionerAPRN11018986FL

General Provider Information

NPI Number : 1487853990
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MELANIE STOVALL FORTENBERRY FNP
Provider Business Mailing Address
First Line : PO BOX 653
Second Line :
City : NEW SMYRNA BEACH
State : FL
Zip : 32170-0653
Country : US
Telephone Number : 706-973-0796
Fax Number :
Provider Business Practice Location Address
First Line : 200 S PARK RD STE 200
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33021-8541
Country : US
Telephone Number : 866-986-2263
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2007
Last Update Date : 05/19/2022

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