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Licensee Information

Nichole Susanna Fortin - PA-C
0010-05229
Active
No
09/08/2014
09/08/2026

Active Supervisor

NameTypeStatusApprovedInactive
Novak, Timothy David, MD MD Active 11/15/2024
Riester, Matthew Edward, MD MD Active 11/15/2024

North Carolina Hospital Admitting Privileges

Location
None Reported

Out of State Active/Inactive Licenses

State
Massachusetts
South Carolina

Out of Country Active/Inactive Licenses

Country
None Reported
Information loaded from this database is current as of 5/10/2026 3:39:42 PM
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