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Provider Information for 1629229018

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

DR. IVY FLETCHER FORKNER M.D.

Gender: FEMALE

Individual NPI: 1629229018

Calendar   Last Updated:  2008-10-04
  Certification Date: 

Details

Name Value
NPI 1629229018
Enumeration Date 2008-10-04
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 1611 NW 12TH AVE
MIAMI, FL 33136-1005
United States

Phone: 919-452-8052 | Fax:
View Map External Link
Primary Practice Address 1611 NW 12TH AVE
MIAMI, FL 33136-1005
United States

Phone: 919-452-8052 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207L00000X - Anesthesiology FL TRN 11633