Provider Demographics
NPI:1033248786
Name:FITZGERALD, CHERYL K (PA-C)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:K
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16839 PARK PLACE ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7819
Mailing Address - Country:US
Mailing Address - Phone:907-694-3303
Mailing Address - Fax:907-694-4773
Practice Address - Street 1:16839 PARK PLACE ST
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7819
Practice Address - Country:US
Practice Address - Phone:907-694-3303
Practice Address - Fax:907-694-4773
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPADA503363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS40618Medicare UPIN