MEDICARE: MRS. LUZ ENEIDA FISCHER-FLORES MSN, APRN,ANP,BC

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	363LA2200X	Adult Health Nurse Practitioner	001810	CT

General Provider Information

NPI Number	:	1386642437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LUZ ENEIDA FISCHER-FLORES MSN, APRN,ANP,BC

Provider Business Mailing Address
First Line	:	18 JAMESTOWN CT
Second Line	:
City	:	GLASTONBURY
State	:	CT
Zip	:	06033-3923
Country	:	US
Telephone Number	:	860-659-3865
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 EXECUTIVE BLVD
Second Line	:
City	:	SOUTHINGTON
State	:	CT
Zip	:	06489-1058
Country	:	US
Telephone Number	:	860-296-2790
Fax Number	:

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/08/2007

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