Provider Demographics
NPI:1316381122
Name:FORTUNA, PAULA (NP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:FORTUNA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03827-3607
Mailing Address - Country:US
Mailing Address - Phone:603-394-7052
Mailing Address - Fax:
Practice Address - Street 1:32 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03827-3607
Practice Address - Country:US
Practice Address - Phone:603-394-7052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159433163W00000X, 282N00000X
MARN159433363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No282N00000XHospitalsGeneral Acute Care Hospital