NPIMap

Individual provider Active NPI

Nicole Leigh Ann Hallberg, PA-C

  • Physician Assistant
  • Daytona Beach, FL
National Provider Identifier
1366814626
Registry record updated Apr 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9110047 Issued in FL
Practice address
305 Memorial Medical Pkwy Ste 505
Daytona Beach, FL 32117-5170
Phone
(386) 231-3540
Fax
(386) 231-3544
NPI assigned
Oct 27, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 28, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9110047 FL Primary

Addresses

Primary practice location

305 Memorial Medical Pkwy Ste 505
Daytona Beach, FL 32117-5170

Mailing address

PO Box 935921
Atlanta, GA 31193-5921

Other names 1

  • Nicole Leigh Ann Castaneda Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161221001653 FL Practitioner - Physician Assistant 4486951415 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Florida Hospital Healthcare Partners, IncGroup PAC ID 7012266836, 621 clinicians

Practice addresses (Care Compare)

1055 Saxon Blvd
Orange City, FL 32763-8468
Phone (386) 917-5000

301 Memorial Medical Pkwy
Daytona Beach, FL 32117-5167
Phone (386) 231-6000

60 Memorial Medical Pkwy
Palm Coast, FL 32164-5980
Phone (386) 586-2000

61 Memorial Medical Pkwy
Palm Coast, FL 32164-5999

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9110047FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Spine & Pain Physicians, LLC CurrentSince Apr 28, 2023 Accepting new patients
Riverside Spine & Pain Physicians, LLC CurrentSince Apr 28, 2023 Accepting new patients
Riverside Anesthesia Services, LLC PastSince Apr 1, 2023 Accepting new patients

Locations

7207 Golden Wings Rd
Ste 100
Jacksonville, FL 32244
Phone (904) 244-3199

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: nicole.castaneda.p1@direct.riversidepain.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: nicole.hallberg.1@8967.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1445904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777334400000",
    "number": "1366814626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 935921",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311935921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 MEMORIAL MEDICAL PKWY STE 505",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175170",
            "telephone_number": "386-231-3540",
            "fax_number": "386-231-3544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLBERG",
        "first_name": "NICOLE",
        "middle_name": "LEIGH ANN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-27",
        "last_updated": "2026-04-28",
        "certification_date": "2026-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9110047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "CASTANEDA",
            "middle_name": "LEIGH ANN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Daytona Beach, FL

Sources for this page

Verify at the official NPI Registry.