Provider Demographics
NPI:1487025615
Name:FISHER, TONYA RENEE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:RENEE
Last Name:FISHER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MRS
Other - First Name:TONYA
Other - Middle Name:R
Other - Last Name:SANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:360 STATION DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7978
Mailing Address - Country:US
Mailing Address - Phone:815-338-6600
Mailing Address - Fax:815-455-8044
Practice Address - Street 1:360 STATION DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014
Practice Address - Country:US
Practice Address - Phone:815-338-6600
Practice Address - Fax:815-455-8044
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.013250363LF0000X
IL041.316748163WC0200X
IL209013250363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209013250OtherSTATE LICENSE