Provider Demographics
NPI:1265684666
Name:FISK, DEBORAH GRACE (RN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:GRACE
Last Name:FISK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7040 LAKE ELLENOR DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-5750
Mailing Address - Country:US
Mailing Address - Phone:407-856-6519
Mailing Address - Fax:407-856-6573
Practice Address - Street 1:7040 LAKE ELLENOR DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5750
Practice Address - Country:US
Practice Address - Phone:407-856-6519
Practice Address - Fax:407-856-6573
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9207457163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse