Nicole Scott, PA, ATC

Key facts

NPI

1164858882

Entity type

Individual (NPI type 1)

Primary specialty

Physician Assistant 363A00000X

License

PA9107524 (FL)

Practice address

8931 Colonial Center Dr Ste 300
Fort Myers, FL 33905-7809

Phone

(239) 938-0800

Fax

(239) 938-0890

NPI assigned

Sep 26, 2013

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Physician Assistant

State licenses

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 28, 2022.

{
    "created_epoch": "1380153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666915200000",
    "number": "1164858882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102222",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303682222",
            "telephone_number": "239-274-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8931 COLONIAL CENTER DR STE 300",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339057809",
            "telephone_number": "239-938-0800",
            "fax_number": "239-938-0890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCOTT",
        "first_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "PA, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-26",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL4456",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "021612",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9107524",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110699000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

• Allison L Scott, PHARM.D.
• Amanda Scott
• Darnell Scott
• David Eduardo Scott, PA
• Maudeen Cassandra Scott, MD
• Peter L Scott, MD
• Tiffany Scott, LCSW
• Angela Marie Scotti
• Michael Lawrence Scotti
• Sarah Elizabeth Scozzafava, M.A.

All providers in Fort Myers, FL · Physician Assistant in Florida