Provider Demographics
NPI:1093391880
Name:FORNBERG, ZOE ELLEN (MSPAS, PA-C, MPH)
Entity Type:Individual
Prefix:MS
First Name:ZOE
Middle Name:ELLEN
Last Name:FORNBERG
Suffix:
Gender:F
Credentials:MSPAS, PA-C, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 THIRD AVENUE SOUTH
Mailing Address - Street 2:APT 741
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233
Mailing Address - Country:US
Mailing Address - Phone:239-287-4632
Mailing Address - Fax:
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-638-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1181510363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant