Provider Demographics
NPI:1407618424
Name:COLLIER-FISHER, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:COLLIER-FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 ISLAND CLUB DR APT 12
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34288-6606
Mailing Address - Country:US
Mailing Address - Phone:941-577-5444
Mailing Address - Fax:
Practice Address - Street 1:3575 ISLAND CLUB DR APT 12
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34288-6606
Practice Address - Country:US
Practice Address - Phone:941-577-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider