Provider Demographics
NPI:1720174121
Name:FISCHER, JILL (APRN, BC)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:FISCHER
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 QUINLEY WAY
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-4131
Mailing Address - Country:US
Mailing Address - Phone:860-443-7296
Mailing Address - Fax:
Practice Address - Street 1:300 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2910
Practice Address - Country:US
Practice Address - Phone:860-886-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000984364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400000948CT01OtherANTHEM BLUE CROSS/BLUE SH