Nicole A Waters

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9116808 Issued in FL

Practice address

3180 Mathieson Dr NE Unit 706
Atlanta, GA 30305-1868

Phone

(949) 355-5017

NPI assigned

Apr 5, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

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

Greater Tampa Bay Physician Specialists LLCGroup PAC ID 2961637715, 33 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida Pasadena Hospital a Part of HCA Florid Hospital, Saint Petersburg, FL, CCN 100126
• HCA Florida St Petersburg Hospital Hospital, Saint Petersburg, FL, CCN 100180
• HCA Florida Northside Hospital Hospital, Saint Petersburg, FL, CCN 100238

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• Direct secure messaging: nicole.waters@hca4.eclinicaldirectplus.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.

• Greater Tampa Bay Physician Specialists, LLC

  • Surgery Physician
  • Tampa, FL
  • NPI 1528492287
  Medicare reassignment Care Compare group

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

• Galen of Florida, Inc.

  • General Acute Care Hospital
  • St Petersburg, FL
  • NPI 1518911031
  Care Compare affiliation
• Galencare, Inc.

  • General Acute Care Hospital
  • St Petersburg, FL
  • NPI 1205880945
  Care Compare affiliation

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683763200000",
    "number": "1598406464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3180 MATHIESON DR NE UNIT 706",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303051868",
            "telephone_number": "949-355-5017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3180 MATHIESON DR NE UNIT 706",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303051868",
            "telephone_number": "949-355-5017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "NICOLE",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-05",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "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": "FL",
            "license": "PA9116808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chiyyia Nycole Waters
• Courtnee Waters, RBT
• Kacie Waters, PHARM.D.
• Kathleen Marie Waters, M.D.
• Lauryn Waters
• Raymond Alan Waters
• Sarah Waters
• Chelsea Watford, RBT
• Margaret Christina Watford, PHARMD.
• Caroline Wathen, M.ED, CF,SLP

• Physician Assistant in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; 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.