Provider Demographics
NPI:1619577566
Name:FIFE, TONI J
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:J
Last Name:FIFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TONI JAMISIN
Other - Middle Name:VICTORIA
Other - Last Name:FIFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:85473 SAGAPONACK DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-8785
Mailing Address - Country:US
Mailing Address - Phone:540-771-4204
Mailing Address - Fax:
Practice Address - Street 1:2800 N 6TH ST STE 5138
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-1920
Practice Address - Country:US
Practice Address - Phone:904-944-6196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180392363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily