Healthcare Provider Details

I. General information

NPI: 1164026258
Provider Name (Legal Business Name): ANGELA JENE PRIMOVIC-FISHER APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 BROWNS LN
COSHOCTON OH
43812-2044
US

IV. Provider business mailing address

440 BROWNS LN
COSHOCTON OH
43812-2044
US

V. Phone/Fax

Practice location:
  • Phone: 888-454-5157
  • Fax:
Mailing address:
  • Phone: 888-454-5157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0027997
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: