MEDICARE: JENNIFER FICKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	35959	TN

General Provider Information

NPI Number	:	1043064256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER FICKE

Provider Business Mailing Address
First Line	:	1040 N JAMES CAMPBELL BLVD
Second Line	:	STE 101
City	:	COLUMBIA
State	:	TN
Zip	:	38401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 N JAMES M CAMPBELL BLVD STE 101
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-2758
Country	:	US
Telephone Number	:	931-840-9991
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	06/18/2024

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Directions to “ JENNIFER FICKE ” Practice Location

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