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General NPI Number Information
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NPI Number | 1639334287
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Entity Type | Individual
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Provider Name | HOLLY FISHER
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Gender | Female
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Dates
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Enumeration Date | 07/23/2008
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Last Update Date | 04/23/2012
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Provider Practice Location Address
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Address Line | 12773 W. FOREST HILL BLVD. SUITE 214
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City | WELLINGTON
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State | FL
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Zip | 33414
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Country | US
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Telephone | 561-386-4351
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Fax |
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Provider Business Mailing Address
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Address Line | 1780 HARBORSIDE CIR
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City | WELLINGTON
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State | FL
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Zip | 33414-8080
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Country | US
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Telephone | 561-386-4351
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN5145078
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA66218
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License Number State | FL
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