Provider Demographics
NPI:1396255063
Name:FITZGERALD, ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4017 N TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:WALKERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46574-9261
Mailing Address - Country:US
Mailing Address - Phone:574-360-9838
Mailing Address - Fax:
Practice Address - Street 1:2771 E US HIGHWAY 6 STE B
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-9341
Practice Address - Country:US
Practice Address - Phone:888-998-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001506A363L00000X
IN28096527A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner