Provider Demographics
NPI:1770912628
Name:FISCUS, JUSTIN (RN)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:FISCUS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 YEMASSEE LOOP
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-1461
Mailing Address - Country:US
Mailing Address - Phone:513-535-3284
Mailing Address - Fax:
Practice Address - Street 1:15580 S US HIGHWAY 441
Practice Address - Street 2:8
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-4426
Practice Address - Country:US
Practice Address - Phone:844-428-9987
Practice Address - Fax:978-232-1981
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health