Provider Demographics
NPI:1235256249
Name:FISH, BARBARA J (CFA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:FISH
Suffix:
Gender:F
Credentials:CFA
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 550321
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-0321
Mailing Address - Country:US
Mailing Address - Phone:954-472-9495
Mailing Address - Fax:954-476-6986
Practice Address - Street 1:1700 SW 100TH TER
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-7474
Practice Address - Country:US
Practice Address - Phone:954-472-9495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL85156363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical