Provider Demographics
NPI:1881787430
Name:FISCHERA, SUSAN D (ARNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:FISCHERA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 CENTERVILLE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-877-5183
Mailing Address - Fax:850-656-1288
Practice Address - Street 1:1401 CENTERVILLE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-877-5183
Practice Address - Fax:850-656-1288
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1699902363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PO4467Medicare UPIN
Y3957Medicare ID - Type Unspecified