Provider Demographics
NPI:1720733207
Name:FISHER, SUMMER
Entity Type:Individual
Prefix:PROF
First Name:SUMMER
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:
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 2161
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34230-2161
Mailing Address - Country:US
Mailing Address - Phone:941-404-3721
Mailing Address - Fax:941-296-7285
Practice Address - Street 1:200 S WASHINGTON BLVD STE 6
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-6957
Practice Address - Country:US
Practice Address - Phone:941-404-3721
Practice Address - Fax:941-296-7285
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-189175106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician