Provider Demographics
NPI:1306027040
Name:FORTNEY, MARGO (APRN)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:
Last Name:FORTNEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 SEVEN SPRINGS WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4511
Mailing Address - Country:US
Mailing Address - Phone:615-846-4558
Mailing Address - Fax:615-461-1726
Practice Address - Street 1:317 SEVEN SPRINGS WAY STE 201
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4511
Practice Address - Country:US
Practice Address - Phone:615-846-4558
Practice Address - Fax:615-461-1726
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012959363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1516131Medicaid