Provider Demographics
NPI:1265830624
Name:FIELDS, JODI (FNP-C)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12464 TIMBERLANE RD
Mailing Address - Street 2:
Mailing Address - City:RALPH
Mailing Address - State:AL
Mailing Address - Zip Code:35480-9103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7700 HIGHWAY 69 S STE C
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-8784
Practice Address - Country:US
Practice Address - Phone:205-349-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-122878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily