Provider Demographics
NPI:1710192133
Name:FORTE, LOUISE M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:M
Last Name:FORTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:M
Other - Last Name:JEAN-SIMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:750 S FEDERAL HWY
Mailing Address - Street 2:MINOR EMERGI CENTER
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-5767
Mailing Address - Country:US
Mailing Address - Phone:954-421-8181
Mailing Address - Fax:954-426-2967
Practice Address - Street 1:750 S FEDERAL HWY
Practice Address - Street 2:MINOR EMERGI CENTER
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-5767
Practice Address - Country:US
Practice Address - Phone:954-421-8181
Practice Address - Fax:954-426-2967
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3113363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant