Provider Demographics
NPI:1912162363
Name:FORTIN, PAULA LYNN (MSN, FNP)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:LYNN
Last Name:FORTIN
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 FENMORE DR
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-5415
Mailing Address - Country:US
Mailing Address - Phone:760-559-5339
Mailing Address - Fax:
Practice Address - Street 1:555 S 7TH AVE
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3043
Practice Address - Country:US
Practice Address - Phone:760-957-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAO574YMedicare PIN