Nicole Wilburn Stokes, PA-C, ATC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9105879 Issued in FL

Practice address

2231 North Blvd W
A
Davenport, FL 33837-8990

Phone

(863) 419-9301

NPI assigned

Mar 2, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Nicole Noel Wilburn Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1299024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299024000000",
    "number": "1255639142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3817 ERIC CT",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338131231",
            "telephone_number": "863-604-1235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2231 NORTH BLVD W",
            "address_2": "A",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338378990",
            "telephone_number": "863-419-9301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOKES",
        "first_name": "NICOLE",
        "middle_name": "WILBURN",
        "name_prefix": "Mrs.",
        "credential": "PA-C, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-02",
        "last_updated": "2011-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9105879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "WILBURN",
            "middle_name": "NOEL",
            "prefix": "MISS",
            "credential": "EMT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Surgical Physician Assistant in Davenport, FL
• Providers in Davenport, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.