Provider Demographics
NPI:1316536956
Name:FABLE, AYISHA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:AYISHA
Middle Name:
Last Name:FABLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5079 N DIXIE HWY # 359
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4000
Mailing Address - Country:US
Mailing Address - Phone:954-940-2231
Mailing Address - Fax:
Practice Address - Street 1:6750 N ANDREWS AVE STE 200
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2180
Practice Address - Country:US
Practice Address - Phone:954-940-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily