Individual
MS. ELLEN R FORTIER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2191 9TH AVE N, SUITE 240, ST PETERSBURG, FL 33713-7146
(727) 821-7163
(727) 822-6017
Mailing address
3212 W FIELDER ST, TAMPA, FL 33611-2912
(813) 966-1699
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 0003227
FL
Other
Enumeration date
01/13/2006
Last updated
07/08/2007
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