MEDICARE: MS. HEATHER REBECCA FISHER

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	133V00000X	Registered Dietitian	ND3568	FL

General Provider Information

NPI Number	:	1518007699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER REBECCA FISHER

Provider Business Mailing Address
First Line	:	2940 E PARK AVE STE 1
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-3446
Country	:	US
Telephone Number	:	850-274-1052
Fax Number	:

Provider Business Practice Location Address
First Line	:	2940 E PARK AVE STE 1
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-3446
Country	:	US
Telephone Number	:	850-274-1052
Fax Number	:

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	05/10/2017

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