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General NPI Number Information
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NPI Number | 1821722190
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Entity Type | Individual
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Provider Name | JONATHAN ADAM FICKO DNP, FNP, EMT-T
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Gender | Male
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 15 WOODSIDE CIR
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City | WOODBURY
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State | CT
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Zip | 06798-1528
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Country | US
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Telephone | 877-422-1145
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Fax |
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Provider Business Mailing Address
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Address Line | 310 ANDRASSY AVE
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City | FAIRFIELD
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State | CT
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Zip | 06824-4107
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Country | US
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Telephone | 203-339-0003
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 12995
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 135613
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License Number State | CT
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