Provider Demographics
NPI:1821722190
Name:FICKO, JONATHAN ADAM (DNP, FNP, EMT-T)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ADAM
Last Name:FICKO
Suffix:
Gender:
Credentials:DNP, FNP, EMT-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 ANDRASSY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-4107
Mailing Address - Country:US
Mailing Address - Phone:203-339-0003
Mailing Address - Fax:
Practice Address - Street 1:15 WOODSIDE CIR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-1528
Practice Address - Country:US
Practice Address - Phone:877-422-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12995363LF0000X
CT135613163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse