Individual provider Active NPI

Aleisha Nicole Thearle, PA-C

  • Surgical Physician Assistant
  • Fort Myers, FL
National Provider Identifier
1114440534
Registry record updated Jul 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
9110478 Issued in FL
Practice address
12670 Creekside LN
Fort Myers, FL 33919-3370
Phone
(239) 482-2663
Fax
(239) 482-7585
NPI assigned
Jul 18, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 9110478 FL Primary

Addresses

Primary practice location

12670 Creekside LN
Fort Myers, FL 33919-3370

Mailing address

17306 Coastal Ridge Dr
Fort Myers, FL 33908-5195
Phone (724) 816-4839

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20170927002181 FL Practitioner - Physician Assistant 1052685252 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Orthopedic Center of Florida, IncGroup PAC ID 9931183639, 48 clinicians

Practice addresses (Care Compare)

12670 Creekside LN
Fort Myers, FL 33919-3370
Phone (239) 482-2663

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
9110478FLMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic Center of Florida, Inc CurrentSince Apr 1, 2025 Accepting new patients
Florida Radiology Consultants P a Past Accepting new patients

Locations

12670 Creekside Ln
Ste 202
Fort Myers, FL 33919
Phone (239) 267-2263

Interoperability endpoints

  • Direct secure messaging: aleisha.thearle.1@22724.direct.athenahealth.com

Organizations & group practices 4

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.

Hospital & facility affiliations 2

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": "1500336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783987200000",
    "number": "1114440534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17306 COASTAL RIDGE DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339085195",
            "telephone_number": "724-816-4839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12670 CREEKSIDE LN",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339193370",
            "telephone_number": "239-482-2663",
            "fax_number": "239-482-7585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEARLE",
        "first_name": "ALEISHA",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-18",
        "last_updated": "2026-07-14",
        "certification_date": "2026-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "9110478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.