Provider Demographics
NPI:1811324114
Name:FISHER, KRISTEN ANNE (PA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANNE
Last Name:FISHER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5616 W NORVELL BRYANT HWY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-7572
Mailing Address - Country:US
Mailing Address - Phone:352-795-1999
Mailing Address - Fax:352-795-2269
Practice Address - Street 1:5616 W NORVELL BRYANT HWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-7572
Practice Address - Country:US
Practice Address - Phone:352-795-1999
Practice Address - Fax:352-795-2269
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107557363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant