NPIMap

Individual provider Active NPI

Jennifer L Fick, PA-C

  • Physician Assistant
  • Daytona Beach, FL
National Provider Identifier
1932182177
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9115186 Issued in FL
Practice address
2276 Green Valley St
Daytona Beach, FL 32124-3055
Phone
(715) 558-3510
NPI assigned
Nov 22, 2005
Last updated
Sep 22, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 748-23 WI
Physician Assistant 363A00000X PA9115186 FL Primary
Preventive Medicine/Occupational Environmental Medicine Physician 2083P0500X 748-023 WI

Addresses

Primary practice location

2276 Green Valley St
Daytona Beach, FL 32124-3055

Mailing address

2276 Green Valley St
Daytona Beach, FL 32124-3055
Phone (715) 558-3510

Other identifiers 4

IdentifierTypeStateIssuer
1932182177MedicaidWI
42946900MedicaidWI
1932182177OtherWIBCBSWI
123081400MedicaidFL

Other names 1

  • Jennifer L Nolden Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jfick306718@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, FL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050526000878 WI Practitioner - Physician Assistant 8224070461 Reassigns benefits to 1 organization
I20240415004038 FL Practitioner - Physician Assistant 8224070461 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1530 Cornerstone Blvd
Suite 120
Daytona Beach, FL 32117-7129

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
748-023WIMDPreventive Medicine/Occupational Environmental Medicine Physician
748-23WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Honor on-Site Clinic Current Accepting new patients
Honor on-Site Clinics Current Accepting new patients
Primecare at Twin Lakes LLC CurrentSince Apr 30, 2024 Accepting new patients
Heathrow Internal Medicine LLC Past Accepting new patients
Paramount Urgent Care Inc Past Accepting new patients
Real Healthcare Past Accepting new patients

Locations

1890 Lpga Blvd
Ste 130
Daytona Beach, FL 32117
Phone (386) 274-2212

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758499200000",
    "number": "1932182177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2276 GREEN VALLEY ST",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321243055",
            "telephone_number": "715-558-3510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2276 GREEN VALLEY ST",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321243055",
            "telephone_number": "715-558-3510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FICK",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-22",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "748-23",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9115186",
            "primary": true
        },
        {
            "code": "2083P0500X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": "WI",
            "license": "748-023",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1932182177",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42946900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSWI",
            "identifier": "1932182177",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123081400",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jfick306718@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "16985 W Bluemound Rd",
            "city": "Brookfield",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530055909",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "16985 W Bluemound Rd",
            "city": "Brookfield",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530055909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "NOLDEN",
            "middle_name": "L",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Daytona Beach, FL

Sources for this page

Verify at the official NPI Registry.