MEDICARE: MRS. TERESSA C FICHTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist
2	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1114234333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESSA C FICHTER

Provider Business Mailing Address
First Line	:	PO BOX 37468
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32236-7468
Country	:	US
Telephone Number	:	904-783-6353
Fax Number	:	904-783-6383

Provider Business Practice Location Address
First Line	:	7630 SADDLE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32221-4425
Country	:	US
Telephone Number	:	904-444-8259
Fax Number	:	904-444-8269

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2010
Last Update Date	:	09/09/2010

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