Provider Demographics
NPI:1356013049
Name:FORTE, MARINA (NP)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:
Last Name:FORTE
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 1:461 7TH ST W STE 3
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-5976
Mailing Address - Country:US
Mailing Address - Phone:707-938-1423
Mailing Address - Fax:707-938-2654
Practice Address - Street 1:461 7TH ST W STE 3
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-5976
Practice Address - Country:US
Practice Address - Phone:707-938-1423
Practice Address - Fax:707-938-2654
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95204178163W00000X
CA95018457363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse