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NPI Code Detail

MEDICARE: MARYSE FORTUNE

MEDICARE: MARYSE FORTUNE
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
1106S00000XBehavior TechnicianRBT-19-80282FL
2104100000XSocial Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558922716
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYSE FORTUNE
Provider Business Mailing Address
First Line : 12220 TOWNE LAKE DR STE 1
Second Line :
City : FORT MYERS
State : FL
Zip : 33913-8021
Country : US
Telephone Number : 239-433-6700
Fax Number : 239-433-6706
Provider Business Practice Location Address
First Line : 12220 TOWNE LAKE DR STE 1
Second Line :
City : FORT MYERS
State : FL
Zip : 33913-8021
Country : US
Telephone Number : 239-433-6700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2019
Last Update Date : 12/18/2025

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Directions to “ MARYSE FORTUNE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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