Provider Demographics
NPI:1376276600
Name:FORTI, CASSANDRA (WHNP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:FORTI
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6353 CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4100
Mailing Address - Country:US
Mailing Address - Phone:757-455-8833
Mailing Address - Fax:
Practice Address - Street 1:828 HEALTHY WAY STE 330
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7959
Practice Address - Country:US
Practice Address - Phone:757-461-3890
Practice Address - Fax:757-467-0301
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184727363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health