Individual provider Active NPI

Nicholas John Newbold Jr., ARNP

  • Gerontology Nurse Practitioner
  • Port Charlotte, FL
National Provider Identifier
1417457425
Registry record updated Feb 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
APRN3395152 Issued in FL
Practice address
22395 Edgewater Dr
Port Charlotte, FL 33980-2012
Phone
(941) 766-7222
Fax
(941) 766-0970
NPI assigned
Feb 16, 2018
Last updated
Feb 23, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X APRN3395152 FL Primary

Addresses

Primary practice location

22395 Edgewater Dr
Port Charlotte, FL 33980-2012

Mailing address

PO Box 102222
Atlanta, GA 30368-2222
Phone (239) 274-8200

Other practice location 1

1390 Grand Venture Dr
North Port, FL 34286-2309
Phone (941) 257-2280

Other identifiers 1

IdentifierTypeStateIssuer
122549300MedicaidFL

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
I20180822001598 FL Practitioner - Nurse Practitioner 9234488370 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

22395 Edgewater Dr
Florida Cancer Specialists P L
Port Charlotte, FL 33980-2012
Phone (941) 766-7222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN3395152FLMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Cancer Specialists & Research Institute, LLC CurrentSince Jun 10, 2024 Accepting new patients
Florida Cancer Specialists & Research Institute, LLC CurrentSince Jun 10, 2024 Accepting new patients
Natalia Capote MD LLC PastSince Feb 1, 2024 Accepting new patients

Locations

1390 Grand Venture Dr
North Port, FL 34286
Phone (941) 257-2280

22395 Edgewater Dr
Fl Cancer
Port Charlotte, FL 33980
Phone (941) 766-7222

22395 Edgewater Dr
Pt Charlotte, FL 33980
Phone (941) 766-7222

1970 Golf St
Fl Cancer
Sarasota, FL 34236
Phone (941) 795-3780

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1518739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771804800000",
    "number": "1417457425",
    "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": "22395 EDGEWATER DR",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339802012",
            "telephone_number": "941-766-7222",
            "fax_number": "941-766-0970"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1390 Grand Venture Dr",
            "address_purpose": "LOCATION",
            "city": "North Port",
            "state": "FL",
            "postal_code": "342862309",
            "country_code": "US",
            "telephone_number": "941-257-2280",
            "fax_number": "941-423-8946",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NEWBOLD",
        "first_name": "NICHOLAS",
        "middle_name": "JOHN",
        "name_suffix": "Jr.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-16",
        "last_updated": "2026-02-23",
        "certification_date": "2026-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "APRN3395152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122549300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.