Susan Jane Nolan, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9105671 Issued in FL

Practice address

22655 Bayshore Rd Ste 110
Port Charlotte, FL 33980-2005

Phone

(941) 235-4900

Fax

(941) 235-4901

NPI assigned

Jan 21, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles (4 of 6)

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: snolan5606@direct.leememorial.org

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

• Lee Health System Inc

  • Internal Medicine Physician
  • Fort Myers, FL
  • NPI 1942058557

  FL

  Medicare reassignment NPD
• Lee Memorial Health System

  • Internal Medicine Physician
  • Fort Myers, FL
  • NPI 1992873319

  FL

  Medicare reassignment
• Pediatric Gastroenterology Hepatology & Nutrition of FL P a

  • Pediatric Gastroenterology Physician
  • St Petersburg, FL
  • NPI 1780787382

  FL

  Medicare reassignment
• Lee Health System Inc

  • Community/Retail Pharmacy
  • Bonita Springs, FL
  • NPI 1699510925
  NPD
• Lee Memorial Health System

  • Federally Qualified Health Center (FQHC)
  • Port Charlotte, FL
  • NPI 1255171765
  NPD
• Lee Memorial Health System

  • Federally Qualified Health Center (FQHC)
  • Fort Myers, FL
  • NPI 1447099973
  NPD

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

{
    "created_epoch": "1295568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1104121243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2147",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339022147",
            "telephone_number": "239-343-6202",
            "fax_number": "239-437-8537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22655 BAYSHORE RD STE 110",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339802005",
            "telephone_number": "941-235-4900",
            "fax_number": "941-235-4901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9400 Gladiolus Drive",
            "address_2": "Suite 250",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339087600",
            "country_code": "US",
            "telephone_number": "239-689-5100",
            "fax_number": "239-689-5107",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16410 Healthpark Commons Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "33908",
            "country_code": "US",
            "telephone_number": "239-343-6202",
            "fax_number": "239-437-8537",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NOLAN",
        "first_name": "SUSAN",
        "middle_name": "JANE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-21",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9105671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004409300",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "snolan5606@Direct.leememorial.org",
            "affiliation": "Y",
            "affiliationName": "Lee Memorial Health System",
            "address_1": "2776 Cleveland Ave",
            "city": "Fort Myers",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339015864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Marcello Nicolosi, RN
• Annia Nimo Martinez, NP
• Jacqueline Marie Noble-Deschenes, NP
• Denise Noel, ARNP
• Philippe Noel, MD
• Minerva Noltee, LMT CNMT CTMP
• Janice G Nord, MD
• Ashlyn Nordgren, MSN
• Yamila Noriega Abreu, DMD
• Marcus David Norman, PA-C

• Medical Physician Assistant in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.