Healthcare Provider Details

I. General information

NPI: 1407334105
Provider Name (Legal Business Name): JENNIFER FICCA FLINCHUM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 MEMORIAL DR STE A
JACKSONVILLE NC
28546
US

IV. Provider business mailing address

260 MEMORIAL DR STE A
JACKSONVILLE NC
28546-6332
US

V. Phone/Fax

Practice location:
  • Phone: 910-915-8450
  • Fax: 888-745-7026
Mailing address:
  • Phone: 910-915-8450
  • Fax: 888-745-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number237018
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number237018
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: