Individual
MARITERE FORTIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
IDHS
Contact information
Practice address
15100 RESCUE WAY, CLEARWATER, FL 33762-3502
(727) 532-2230
(727) 532-2231
Mailing address
15100 RESCUE WAY, CLEARWATER, FL 33762-3502
(727) 532-2230
(727) 532-2231
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1397074753
DOD ID NUMBER
—
Enumeration date
09/23/2021
Last updated
09/23/2021
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