NPIMap

Individual provider Active NPI

Nicole Outten, MD

  • Student in an Organized Health Care Education/Training Program
  • Fort Myers, FL
National Provider Identifier
1568619476
Registry record updated Jun 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
43349 Issued in FL
Practice address
2776 Cleveland Ave
Fort Myers, FL 33901
Phone
(239) 343-2606
Fax
(239) 343-3695
NPI assigned
Aug 21, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2025

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 PA9104426 FL
Student in an Organized Health Care Education/Training Program 390200000X 43349 FL Primary

Addresses

Primary practice location

2776 Cleveland Ave
Fort Myers, FL 33901

Mailing address

2776 Cleveland Ave
Fort Myers, FL 33901-5864
Phone (239) 343-2606

Other practice location 1

2776 Cleveland Ave
Fort Myers, FL 33901
Phone (239) 343-2606

Other practice location 2

3592 Broadway Ste 100
Fort Myers, FL 33901-8056
Phone (239) 345-8001

Other identifiers 1

IdentifierTypeStateIssuer
001888400MedicaidFL

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
I20100324001167 FL Practitioner - Physician Assistant 1456487883 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9104426FLMDPhysician Assistant
43349FLMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Emcare Physician Providers, Inc. Past Accepting new patients
Emcare Physician Providers, Inc. Past Accepting new patients
Preferred Inpatient Medical Program Specialists Past Accepting new patients
Jimmy Liu, M.D., P.a. Past Accepting new patients
Leeland ER SVCS Partnership LLC Past Accepting new patients

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1219276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750032000000",
    "number": "1568619476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2776 CLEVELAND AVE",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339015864",
            "telephone_number": "239-343-2606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2776 CLEVELAND AVE",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "33901",
            "telephone_number": "239-343-2606",
            "fax_number": "239-343-3695"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2776 Cleveland Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "33901",
            "country_code": "US",
            "telephone_number": "239-343-2606",
            "fax_number": "239-343-3695",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3592 Broadway Ste 100",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339018056",
            "country_code": "US",
            "telephone_number": "239-345-8001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OUTTEN",
        "first_name": "NICOLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-21",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9104426",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "43349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001888400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.