Provider Demographics
NPI:1679933485
Name:FISHWICK, ANNE HALLETT (FNP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:HALLETT
Last Name:FISHWICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S LAMAR BLVD
Mailing Address - Street 2:APT. #3004
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-0119
Mailing Address - Country:US
Mailing Address - Phone:510-499-3916
Mailing Address - Fax:
Practice Address - Street 1:600 W HILLSBORO BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:DEERFIELD BCH
Practice Address - State:FL
Practice Address - Zip Code:33441-1609
Practice Address - Country:US
Practice Address - Phone:954-990-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily