Nicholle Co Nacionales, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

14764 Issued in MN

Practice address

4645 Trenton Cir N
Plymouth, MN 55442-3146

Phone

(763) 234-7928

NPI assigned

Sep 2, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Healtheast Medical Research InstituteGroup PAC ID 3971407636, 665 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• M Health Fairview Woodwinds Hospital Hospital, Woodbury, MN, CCN 240213
• M Health Fairview St John'S Hospital Hospital, Maplewood, MN, CCN 240210

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nnacionales780073@fairview.direct-ci.com

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

• Healtheast Medical Research Institute

  • Clinic/Center
  • Vadnais Heights, MN
  • NPI 1639125503
  Medicare reassignment Care Compare group
• Healtheast Medical Research Institute

  • Internal Medicine Physician
  • Saint Paul, MN
  • NPI 1508191552
  NPD
• Healtheast Medical Research Institute

  • Surgery Physician
  • Maplewood, MN
  • NPI 1750791810
  NPD
• Healtheast Medical Research Institute

  • Clinic/Center
  • Oakdale, MN
  • NPI 1073569935
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Healtheast St. John'S Hospital

  • General Acute Care Hospital
  • Maplewood, MN
  • NPI 1447218482
  Care Compare affiliation
• Healtheast Woodwinds Hospital

  • General Acute Care Hospital
  • Woodbury, MN
  • NPI 1356309322
  Care Compare affiliation

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

{
    "created_epoch": "1630540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704240000000",
    "number": "1467120451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4645 TRENTON CIR N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554423146",
            "telephone_number": "763-234-7928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4645 TRENTON CIR N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554423146",
            "telephone_number": "763-234-7928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NACIONALES",
        "first_name": "NICHOLLE",
        "middle_name": "CO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-02",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fatima Mustafa
• Mustard Seed Counseling, LLC
• Kelly Mwei, MSW, LICSW
• N and N Interpreters Compmay
• Nicole Ann Naas
• Alexandria Nash
• Marissa Lauren Natzel
• Navigating Changes LLC
• Dovile Nazarevych
• Gladys Ayiera Ndege, CNP

• Physician Assistant in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.