Individual provider Active NPI

Nicole Jackson Holcombe, CRNA

  • Certified Registered Nurse Anesthetist
  • Niceville, FL
National Provider Identifier
1598513996
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
11032749 Issued in FL
Practice address
106 Swift Creek CT
Niceville, FL 32578-3710
Phone
(443) 867-0516
NPI assigned
May 9, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 11032749 FL Primary

Addresses

Primary practice location

106 Swift Creek CT
Niceville, FL 32578-3710

Mailing address

106 Swift Creek CT
Niceville, FL 32578-3710
Phone (443) 867-0516

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240808000329 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 5890232854 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1000 Mar Walt Dr
Fort Walton Beach, FL 32547-6708
Phone (954) 939-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11032749FLMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Physician Solutions of North Florida, LLC Nurse Anesthetist, Certified Registered CurrentSince Jul 1, 2024 Accepting new patients
Anesthesia Physician Solutions of North Florida, LLC CurrentSince Jul 1, 2024 Accepting new patients

Locations

1000 Mar Walt Dr
Ft Walton Bch, FL 32547
Phone (850) 374-9610

325 Cypress Pkwy
Poinciana, FL 34759
Phone (407) 530-2000

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1715212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1598513996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 SWIFT CREEK CT",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325783710",
            "telephone_number": "443-867-0516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 SWIFT CREEK CT",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325783710",
            "telephone_number": "443-867-0516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLCOMBE",
        "first_name": "NICOLE",
        "middle_name": "JACKSON",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-09",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "11032749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niceville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.