Healthcare Provider Details

I. General information

NPI: 1881787430
Provider Name (Legal Business Name): SUSAN D FISCHERA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 CENTERVILLE ROAD SUITE 100
TALLAHASSEE FL
32308
US

IV. Provider business mailing address

1401 CENTERVILLE ROAD SUITE 100
TALLAHASSEE FL
32308
US

V. Phone/Fax

Practice location:
  • Phone: 850-877-5183
  • Fax: 850-656-1288
Mailing address:
  • Phone: 850-877-5183
  • Fax: 850-656-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP1699902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: