Provider Demographics
NPI:1235194903
Name:FISHER, JOANN (ARNP)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 VENTURE DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5130
Mailing Address - Country:US
Mailing Address - Phone:941-924-9955
Mailing Address - Fax:941-924-5165
Practice Address - Street 1:6320 VENTURE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5130
Practice Address - Country:US
Practice Address - Phone:941-924-9955
Practice Address - Fax:941-924-5165
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1072712363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303125000Medicaid
S99295Medicare UPIN
FL303125000Medicaid