Provider Demographics
NPI:1114234333
Name:FICHTER, TERESSA C
Entity Type:Individual
Prefix:MRS
First Name:TERESSA
Middle Name:C
Last Name:FICHTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37468
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32236-7468
Mailing Address - Country:US
Mailing Address - Phone:904-783-6353
Mailing Address - Fax:904-783-6383
Practice Address - Street 1:7630 SADDLE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-4425
Practice Address - Country:US
Practice Address - Phone:904-444-8259
Practice Address - Fax:904-444-8269
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty