1033315213 NPI number — JEAN HERSHEY FITCH ARNP

Table of content: JEAN HERSHEY FITCH ARNP (NPI 1033315213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033315213 NPI number — JEAN HERSHEY FITCH ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITCH
Provider First Name:
JEAN
Provider Middle Name:
HERSHEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HERSHEY
Provider Other First Name:
JEAN
Provider Other Middle Name:
HELEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
9240853ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033315213
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9246 ESTERO RIVER CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESTERO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33928-4417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-470-8011
Provider Business Mailing Address Fax Number:
239-590-7968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FLORIDA GULF COAST UNIVERSITY STUDENT HEALTH SERVICES
Provider Second Line Business Practice Location Address:
10501 FGCU BOULEVARD SOUTH
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33965-6565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-590-7966
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP 9240853 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)