Provider Demographics
NPI:1972060507
Name:FISHER, JILLIAN RENEE (FNP-C)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:RENEE
Last Name:FISHER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2481 MONTCLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1319
Mailing Address - Country:US
Mailing Address - Phone:843-504-4880
Mailing Address - Fax:
Practice Address - Street 1:1874 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2263
Practice Address - Country:US
Practice Address - Phone:330-262-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH024343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily