NPIMap

Individual provider Active NPI

Tina Marie Fort, APRN, NP-C

  • Family Nurse Practitioner
  • Eufaula, OK
National Provider Identifier
1033763776
Registry record updated Oct 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
83414 Issued in OK
Practice address
218 N Main St
Eufaula, OK 74432-1633
Phone
(918) 689-7705
NPI assigned
Jul 31, 2019
Last updated
Oct 15, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 83414 OK Primary

Addresses

Primary practice location

218 N Main St
Eufaula, OK 74432-1633

Mailing address

4196 Highway 62 412 Ste a
Hardy, AR 72542-8002

Other practice location 1

709 E Downing St
Tahlequah, OK 74464-3213
Phone (918) 458-9444

Other practice location 2

1504 N Cedar Ave
Tahlequah, OK 74464-6700
Phone (918) 456-3456

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200422001157 OK Practitioner - Nurse Practitioner 8921438581 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
AMC Medical Clinic I LLCGroup PAC ID 6901235563, 12 clinicians

Practice addresses (Care Compare)

218 N Main St
Eufaula, OK 74432-1633
Phone (918) 689-7705

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
83414OKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
AMC Medical Clinic I LLC CurrentSince Apr 15, 2020 Accepting new patients
Access Medical Clinic LLC Past Accepting new patients
Access Medical Clinic LLC Past Accepting new patients
Access Medical Clinic LLC PastSince Jan 1, 2024 Accepting new patients
Northeastern Health System Past Accepting new patients

Locations

4196 Highway 62 412
#A
Hardy, AR 72542
Phone (870) 856-2100

218 N Main St
Eufaula, OK 74432
Phone (918) 689-7705

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21087/brand/1/csg/1/fhir/r4
  • Direct secure messaging: tina.fort.1@21087.direct.athenahealth.com
  • Direct secure messaging: tina.fort.1@22155.direct.athenahealth.com
  • Direct secure messaging: tina.fort.1@2424.direct.athenahealth.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760486400000",
    "number": "1033763776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4196 HIGHWAY 62 412 STE A",
            "city": "HARDY",
            "state": "AR",
            "postal_code": "725428002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 N MAIN ST",
            "city": "EUFAULA",
            "state": "OK",
            "postal_code": "744321633",
            "telephone_number": "918-689-7705"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "709 E Downing St",
            "address_purpose": "LOCATION",
            "city": "Tahlequah",
            "state": "OK",
            "postal_code": "744643213",
            "country_code": "US",
            "telephone_number": "918-458-9444",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1504 N Cedar Ave",
            "address_purpose": "LOCATION",
            "city": "Tahlequah",
            "state": "OK",
            "postal_code": "744646700",
            "country_code": "US",
            "telephone_number": "918-456-3456",
            "fax_number": "855-860-5341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORT",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "credential": "APRN, NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-31",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "83414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eufaula, OK

Sources for this page

Verify at the official NPI Registry.