Individual
MRS. AMY J FORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1426 LONGOAK DR S, LAKELAND, FL 33811-2115
(863) 640-7013
Mailing address
1426 LONGOAK DR S, LAKELAND, FL 33811-2115
(863) 640-7013
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
ARNP9216870
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3074820-00
—
FL
01
—
DC8324
RAILROAD MEDICARE
FL
Enumeration date
05/04/2006
Last updated
08/12/2024
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