Nicole Russo Cavignaro, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9117532 Issued in FL

Practice address

316 Paseo Reyes Dr
St Augustine, FL 32095-8464

Phone

(904) 544-5800

Fax

(904) 544-5800

NPI assigned

Jan 9, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bold City Dermatology LLCGroup PAC ID 2769897974, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Bold City Dermatology LLC

  • MOHS-Micrographic Surgery Physician
  • St Augustine, FL
  • NPI 1538761655
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1641686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1508527748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 PASEO REYES DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320958464",
            "telephone_number": "904-544-5800",
            "fax_number": "904-544-5800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 PASEO REYES DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320958464",
            "telephone_number": "904-544-5800",
            "fax_number": "904-544-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAVIGNARO",
        "first_name": "NICOLE",
        "middle_name": "RUSSO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-09",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9117532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Wayne Cater, D.O.
• Bruce D Cathcart, MPT
• Anthony V Catoggio, BA
• Jeremy Alan Caudill, D.O.
• Timothy J Cavacini, D.O.
• Alicia Cazzolla, RN,IBCLC
• Serena Cecere, MS
• Iris Cedeno, ARNP
• Arianna Renee Celano
• Maried Esther Celkis, M.D.

• Physician Assistant in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.