Provider Demographics
NPI:1154074292
Name:FORTUNATO, JASON DOMINIC (FNP)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:DOMINIC
Last Name:FORTUNATO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MANNING RD
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-9524
Mailing Address - Country:US
Mailing Address - Phone:330-256-0504
Mailing Address - Fax:
Practice Address - Street 1:75 ARCH ST STE G2
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1430
Practice Address - Country:US
Practice Address - Phone:330-375-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0030571363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty