Provider Demographics
NPI:1639459894
Name:FISH, JULIETTE D (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:JULIETTE
Middle Name:D
Last Name:FISH
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:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93102-0689
Mailing Address - Country:US
Mailing Address - Phone:805-682-7111
Mailing Address - Fax:805-569-7890
Practice Address - Street 1:320 W PUEBLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4311
Practice Address - Country:US
Practice Address - Phone:805-682-7111
Practice Address - Fax:805-569-7890
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily