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1699754002
ELLEN R FORTIER
ST PETERSBURG, FL
NPI
1699754002
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: FL PA 0003227)
Enumeration Date
2006-01-13
Last Update Date
2007-07-08
Business Address
Ms. ELLEN R FORTIER PA
2191 9TH AVE N SUITE 240
ST PETERSBURG, FL 33713-7146
Phone number: 727-821-7163
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Mailing Address
Ms. ELLEN R FORTIER PA
3212 W FIELDER ST
TAMPA, FL 33611-2912
Phone number: 813-966-1699
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