Provider Demographics
NPI:1417451683
Name:FORTUNE, CHASITY DANIELLE (NP-C)
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:DANIELLE
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 CLOVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35633-1301
Mailing Address - Country:US
Mailing Address - Phone:256-284-7706
Mailing Address - Fax:256-284-7711
Practice Address - Street 1:108 AVALON AVE
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2800
Practice Address - Country:US
Practice Address - Phone:256-284-7706
Practice Address - Fax:256-284-7711
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF01181317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily