Provider Demographics
NPI:1407543945
Name:FISHER, JENNIFER SHIRLIEAN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SHIRLIEAN
Last Name:FISHER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1964
Mailing Address - Country:US
Mailing Address - Phone:860-224-5433
Mailing Address - Fax:
Practice Address - Street 1:406 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1964
Practice Address - Country:US
Practice Address - Phone:860-677-9624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6143363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical