Healthcare Provider Details

I. General information

NPI: 1639334287
Provider Name (Legal Business Name): HOLLY FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12773 W. FOREST HILL BLVD. SUITE 214
WELLINGTON FL
33414
US

IV. Provider business mailing address

1780 HARBORSIDE CIR
WELLINGTON FL
33414-8080
US

V. Phone/Fax

Practice location:
  • Phone: 561-386-4351
  • Fax:
Mailing address:
  • Phone: 561-386-4351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5145078
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA66218
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: