Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | GA204328 | GA |
N | 363LG0600X | Nurse Practitioner - Gerontology | GA204328 | GA |
NPI | 1083039994 |
---|---|
Provider Name | Briana Ellen Forte |
First Address | Macon, GA 31201-2102 |
Second Address | Macon, GA 31201-2102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2014 |
Last Update Date | 08/03/2014 |