# MR. JOHN BRYCE FITZGERALD

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1609590389
- **Gender:** Man
- **Credential:** APRN, AGACNP-BC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 28207179C | IN | Yes |
| 363LA2100X | Acute Care Nurse Practitioner | 28207179C | IN | — |
| 363LG0600X | Gerontology Nurse Practitioner | 28207179C | IN | — |

## Other

- **Enumeration date:** 09/27/2022
- **Last updated:** 12/02/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100861520 | — | KY |
| 01 | — | IN1920035 | MEDICARE | IN |
| 01 | — | K4121802 | MEDICARE | KY |