Provider Demographics
NPI:1972074383
Name:FISCHER, LISA ANN MARIE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN MARIE
Last Name:FISCHER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 EASTERWOOD CT SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-6835
Mailing Address - Country:US
Mailing Address - Phone:321-480-7611
Mailing Address - Fax:
Practice Address - Street 1:1250 S HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3242
Practice Address - Country:US
Practice Address - Phone:321-725-8919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily