Provider Demographics
NPI:1952401093
Name:FISHER, JENNIFER LOUISE (RN,MS,CFNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LOUISE
Last Name:FISHER
Suffix:
Gender:F
Credentials:RN,MS,CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N SUMMIT ST FL 7
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1620 BRIGHAM DR STE 240
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7124
Practice Address - Country:US
Practice Address - Phone:419-872-7700
Practice Address - Fax:419-874-0196
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704222999363LF0000X
OHCOA.04253-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000055060OtherANTHEM
OH2176292Medicaid
$$$$$$$$$OtherHEATH NET TRICARE
OH2176292Medicaid