Individual
MS. LATEISHA NICOLE FORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN-FPA
Contact information
Practice address
1 INGALLS DR, HARVEY, IL 60426-3558
(708) 596-3344
(708) 596-3432
Mailing address
18241 WEST ST STE 209, LANSING, IL 60438-3200
(800) 897-4575
(800) 306-9509
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
277002648
IL
363LG0600X
Gerontology Nurse Practitioner
277002648
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
921750533001
—
IL
Enumeration date
05/22/2018
Last updated
03/23/2026
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