Healthcare Provider Details

I. General information

NPI: 1124307376
Provider Name (Legal Business Name): KIMBERLY HOPE FISHER CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SARNO RD SUITE 15
MELBOURNE FL
32935-4938
US

IV. Provider business mailing address

3100 W END AVE SUITE 400
NASHVILLE TN
37203-1320
US

V. Phone/Fax

Practice location:
  • Phone: 800-348-4565
  • Fax: 888-468-6511
Mailing address:
  • Phone: 615-345-5581
  • Fax: 888-830-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: