MEDICARE: ANTHONY 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	101YP1600X	Pastoral Counselor
2	163W00000X	Registered Nurse	RN9356853	FL

General Provider Information

NPI Number	:	1669939286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY FISHER

Provider Business Mailing Address
First Line	:	193 BRADFORD LAKE CIR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-0103
Country	:	US
Telephone Number	:	904-697-8553
Fax Number	:

Provider Business Practice Location Address
First Line	:	193 BRADFORD LAKE CIR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-0103
Country	:	US
Telephone Number	:	904-697-8553
Fax Number	:

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

Provider Enumeration Date	:	03/01/2019
Last Update Date	:	03/01/2019

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