Provider Demographics
NPI:1932182177
Name:FICK, JENNIFER L (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:FICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:NOLDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2276 GREEN VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32124-3055
Mailing Address - Country:US
Mailing Address - Phone:715-558-3510
Mailing Address - Fax:
Practice Address - Street 1:2276 GREEN VALLEY ST
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32124-3055
Practice Address - Country:US
Practice Address - Phone:715-558-3510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI748-23363A00000X
WI748-0232083P0500X
FLPA9115186363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42946900Medicaid
WI1932182177OtherBCBSWI
WI1932182177Medicaid
FL123081400Medicaid
WI1932182177OtherBCBSWI
WINOLDEJENOtherMERCYCARE INSURANCE
WI1932182177Medicaid