MEDICARE: DR. TINA FISCHER-CARNE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME0073965	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912995499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TINA FISCHER-CARNE MD

Provider Business Mailing Address
First Line	:	125 FLORIDA MEMORIAL PKWY
Second Line	:	SUITE 2700
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-9356
Country	:	US
Telephone Number	:	386-409-6871
Fax Number	:	386-409-6914

Provider Business Practice Location Address
First Line	:	125 FLORIDA MEMORIAL PKWY
Second Line	:	SUITE 2700
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-9356
Country	:	US
Telephone Number	:	386-409-6871
Fax Number	:	386-409-6914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	04/22/2015

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