Provider Demographics
NPI:1346703824
Name:FISHER, KRISTY ANNE (MD, MS, MBA)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:ANNE
Last Name:FISHER
Suffix:
Gender:F
Credentials:MD, MS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:151 N NOB HILL RD STE 3311
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1708
Mailing Address - Country:US
Mailing Address - Phone:561-549-9090
Mailing Address - Fax:954-353-5154
Practice Address - Street 1:280 SW NATURA AVE
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-3026
Practice Address - Country:US
Practice Address - Phone:561-549-9090
Practice Address - Fax:561-549-9091
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1611792084P0800X, 208VP0014X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program