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Individual
MRS. TINA RENEE FISHER
Active
Individual
MRS. TINA RENEE FISHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28113301A
IN
363L00000X
Nurse Practitioner
Primary
71002159A
IN
363LF0000X
Family Nurse Practitioner
71002159
IN
363LF0000X
Family Nurse Practitioner
71002159A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000704579
ANTHEM
IN
01
—
11813513
CAQH
—
05
—
200873280
—
IN
Enumeration date
10/01/2006
Last updated
11/13/2017
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