Healthcare Provider Details

I. General information

NPI: 1659316024
Provider Name (Legal Business Name): JILL FISCHER-PETERS L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 PARK BLVD STE 206
SEMINOLE FL
33776-3439
US

IV. Provider business mailing address

13800 PARK BLVD STE 206
SEMINOLE FL
33776-3439
US

V. Phone/Fax

Practice location:
  • Phone: 727-391-9800
  • Fax: 727-391-9882
Mailing address:
  • Phone: 727-391-9800
  • Fax: 727-391-9882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7731
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: