Provider Demographics
NPI:1396047726
Name:FISHER, TIFFANY ANGELINE (MT, APP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ANGELINE
Last Name:FISHER
Suffix:
Gender:F
Credentials:MT, APP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 CENTRAL SQUARE
Mailing Address - Street 2:UNIT 4
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824
Mailing Address - Country:US
Mailing Address - Phone:978-866-7453
Mailing Address - Fax:
Practice Address - Street 1:61 CENTRAL SQ
Practice Address - Street 2:UNIT 4
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3096
Practice Address - Country:US
Practice Address - Phone:978-866-7453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7751171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor