Provider Demographics
NPI:1033297494
Name:FISHER, NICOLE A (PA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:A
Last Name:FISHER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BANNING ST
Mailing Address - Street 2:STE 200
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3487
Mailing Address - Country:US
Mailing Address - Phone:302-674-0600
Mailing Address - Fax:302-672-7144
Practice Address - Street 1:540 S GOVERNORS AVE
Practice Address - Street 2:STE100A
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3530
Practice Address - Country:US
Practice Address - Phone:302-674-0600
Practice Address - Fax:302-672-7144
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000341363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000023182Medicaid
DEP81436Medicare UPIN
DEP00118351Medicare ID - Type Unspecified