MEDICARE: JENNIFER L FICK PA-C

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	748-23	WI
2	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	748-023	WI
3	363A00000X	Physician Assistant	PA9115186	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1932182177	OTHER	WI	BCBSWI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1932182177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L FICK PA-C

Provider Business Mailing Address
First Line	:	2276 GREEN VALLEY ST
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32124-3055
Country	:	US
Telephone Number	:	715-558-3510
Fax Number	:

Provider Business Practice Location Address
First Line	:	2276 GREEN VALLEY ST
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32124-3055
Country	:	US
Telephone Number	:	715-558-3510
Fax Number	:

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	09/22/2025

7900 N KINGS HWY STE A
MYRTLE BEACH, SC
29572-3055

Practice Phone: 843-449-3381
Practice Fax: 843-839-0275