Healthcare Provider Details

I. General information

NPI: 1821722190
Provider Name (Legal Business Name): JONATHAN ADAM FICKO DNP, FNP, EMT-T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 WOODSIDE CIR
WOODBURY CT
06798-1528
US

IV. Provider business mailing address

310 ANDRASSY AVE
FAIRFIELD CT
06824-4107
US

V. Phone/Fax

Practice location:
  • Phone: 877-422-1145
  • Fax:
Mailing address:
  • Phone: 203-339-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12995
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number135613
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: