Individual
JEREMY FICKEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
750 N ESTRELLA PKWY, STE 40, GOODYEAR, AZ 85338-9272
(623) 889-3477
(623) 889-3478
Mailing address
PO BOX 5204, GOODYEAR, AZ 85338-0603
(619) 981-9432
(623) 889-3478
Taxonomy
Speciality
Code
Description
License number
State
261QA0005X
Ambulatory Family Planning Facility
147824
AZ
261QA0005X
Ambulatory Family Planning Facility
583861
CA
363LF0000X
Family Nurse Practitioner
Primary
147824
AZ
Other
Enumeration date
01/20/2015
Last updated
04/07/2015
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