Individual provider Active NPI

Nicholas Cieslak, PA

  • Physician Assistant
  • Tampa, FL
National Provider Identifier
1275280117
Registry record updated Aug 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9116216 Issued in FL
Practice address
909 N Dale Mabry Hwy
Tampa, FL 33609-1251
Phone
(813) 978-9700
NPI assigned
Mar 9, 2022
Last updated
Aug 3, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9116216 FL Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

909 N Dale Mabry Hwy
Tampa, FL 33609-1251

Mailing address

13020 N Telecom Pkwy
Temple Terrace, FL 33637-0915

Other practice location 1

560 S Lakewood Dr Ste 101
Brandon, FL 33511-5015
Phone (813) 978-9700

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
I20220815002771 FL Practitioner - Physician Assistant 2668855289 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians

Practice addresses (Care Compare)

17470 Brookside Trace CT
Tampa, FL 33647-6201
Phone (813) 443-5042

3334 Capital Medical Blvd
Suite 400
Tallahassee, FL 32308-4470
Phone (850) 877-8174

5016 W Cypress St
Suite 210
Tampa, FL 33607-3809
Phone (813) 978-9700

560 S Lakewood Dr
101 Florida Orthopaedic Institute
Brandon, FL 33511-5015
Phone (813) 978-9700

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9116216FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Musculoskeletal Institute Chartered CurrentSince Sep 6, 2022 Accepting new patients
Musculoskeletal Institute Chartered CurrentSince Sep 6, 2022 Accepting new patients
Tallahassee Orthopedic Clinic III, P.L. CurrentSince Sep 11, 2024 Accepting new patients
Musculoskeletal Institute Chartered Past Accepting new patients

Locations

560 S Lakewood Dr
Ste 101
Brandon, FL 33511
Phone (813) 558-6044

2605 Welaunee Blvd
Tallahassee, FL 32308

909 N Dale Mabry Hwy
Tampa, FL 33609
Phone (813) 287-9370

13020 N Telecom Pkwy
Temple Terrace, FL 33637

13020 N Telecom Pkwy
Fl Orthopaedic
Temple Terrace, FL 33637

13060 N Telecom Pkwy
Fl Orthopaedic
Temple Terrace, FL 33637

5901 E Fowler Ave
Ste 100
Temple Terrace, FL 33617
Phone (813) 987-9700

2044 Trinity Oaks Blvd
Ste 110
Trinity, FL 34655
Phone (813) 978-7000

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: nicholas.cieslak.1@18802.direct.athenahealth.com

Organizations & group practices 5

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

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": "1646784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659484800000",
    "number": "1275280117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13020 N TELECOM PKWY",
            "city": "TEMPLE TERRACE",
            "state": "FL",
            "postal_code": "336370915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 N DALE MABRY HWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336091251",
            "telephone_number": "813-978-9700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "560 S Lakewood Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Brandon",
            "state": "FL",
            "postal_code": "335115015",
            "country_code": "US",
            "telephone_number": "813-978-9700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CIESLAK",
        "first_name": "NICHOLAS",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-09",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9116216",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.