Individual provider Active NPI

Alexis Fortner, MSN, APRN, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Tampa, FL
National Provider Identifier
1053296764
Registry record updated Aug 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
11041455 Issued in FL
Practice address
4620 N Habana Ave Ste 101
Tampa, FL 33614-7107
Phone
(813) 875-9362
Fax
(813) 876-7055
NPI assigned
Aug 11, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 11041455 FL Primary
Gerontology Nurse Practitioner 363LG0600X 11041455 FL

Addresses

Primary practice location

4620 N Habana Ave Ste 101
Tampa, FL 33614-7107

Mailing address

4620 N Habana Ave Ste 101
Tampa, FL 33614-7107
Phone (813) 875-9362

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251112004094 FL Practitioner - Nurse Practitioner 1456857713 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Indiana University School of Medicine, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tampa Pulmonary and Sleep Specialist MDS LLP Gen PTRGroup PAC ID 5193717106, 11 clinicians

Practice addresses (Care Compare)

4620 N Habana Ave
Suite 101
Tampa, FL 33614-7107
Phone (813) 875-9362

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11041455FLMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tampa Pulmonary and Sleep Specialist MDS LLP Gen PTR CurrentSince Nov 1, 2025 Accepting new patients

Locations

4620 N Habana Ave
Ste 101
Tampa, FL 33614
Phone (813) 875-9362

Organizations & group practices 1

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

Hospital & facility affiliations 3

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": "1754870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785888000000",
    "number": "1053296764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4620 N HABANA AVE STE 101",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336147107",
            "telephone_number": "813-875-9362",
            "fax_number": "813-876-7055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4620 N HABANA AVE STE 101",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336147107",
            "telephone_number": "813-875-9362",
            "fax_number": "813-876-7055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTNER",
        "first_name": "ALEXIS",
        "credential": "MSN, APRN, AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-11",
        "last_updated": "2026-08-05",
        "certification_date": "2026-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "FL",
            "license": "11041455",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "11041455",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.