Individual
DR. DIANE L FORTUNATO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2412 QUIRT LN, PUNTA GORDA, FL 33983-2627
(941) 764-9480
Mailing address
2412 QUIRT LN, PUNTA GORDA, FL 33983-2627
(941) 764-9480
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MA04648600
NJ
207R00000X
Internal Medicine Physician
Primary
63562
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1868501
—
NJ
Enumeration date
08/12/2005
Last updated
06/19/2021
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