Provider Demographics
NPI:1457625568
Name:MORTARA, JEANETTE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:
Last Name:MORTARA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750A SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-3316
Mailing Address - Country:US
Mailing Address - Phone:251-662-7317
Mailing Address - Fax:251-066-2729
Practice Address - Street 1:301 W LAUREL AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-1920
Practice Address - Country:US
Practice Address - Phone:251-972-8220
Practice Address - Fax:251-943-4486
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 1952492363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health