Provider Demographics
NPI:1306722764
Name:FORTUNE, PRESLEY JO (CRNP)
Entity type:Individual
Prefix:
First Name:PRESLEY
Middle Name:JO
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 GREEN LEAF TER
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-4631
Mailing Address - Country:US
Mailing Address - Phone:765-465-6309
Mailing Address - Fax:
Practice Address - Street 1:14090 HG TRUEMAN RD # 2500
Practice Address - Street 2:
Practice Address - City:SOLOMONS
Practice Address - State:MD
Practice Address - Zip Code:20688-3151
Practice Address - Country:US
Practice Address - Phone:410-326-0305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR260200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily