Provider Demographics
NPI:1164429346
Name:FICHERA, JEFFREY S (PA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:FICHERA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 BENMORE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4143
Mailing Address - Country:US
Mailing Address - Phone:407-644-4883
Mailing Address - Fax:407-644-3697
Practice Address - Street 1:133 BENMORE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4143
Practice Address - Country:US
Practice Address - Phone:407-644-4883
Practice Address - Fax:407-644-3697
Is Sole Proprietor?:No
Enumeration Date:2005-07-04
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2647363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
970016626OtherRR MEDICARE
970016627OtherRR MEDICARE
FL291070500Medicaid
01103936OtherAMERIGROUP
970016628OtherRR MEDICARE
S71709Medicare UPIN
FL291070500Medicaid