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Provider Information for 1326096264

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

MRS. AMY J FORT ARNP

Gender: FEMALE

Individual NPI: 1326096264

Calendar   Last Updated:  2018-10-18
  Certification Date: 

Details

Name Value
NPI 1326096264
Enumeration Date 2006-05-04
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 270 MAIN ST N STE 300
STILLWATER, MN 55082-6788
United States

Phone: 651-472-8191 | Fax:
View Map External Link
Primary Practice Address 10150 HIGHLAND MANOR DR STE 240
TAMPA, FL 33610-9750
United States

Phone: 813-259-1013 | Fax:
View Map External Link
Secondary Practice Address 3470 LAKELAND HILLS BLVD
LAKELAND, FL 33805
United States

Phone: 863-682-0027 | Fax:
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID FL 3074820-00
Other RAILROAD MEDICARE FL DC8324
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LF0000X - Nurse Practitioner Family FL ARNP9216870