Nicole B Earley, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9121949 Issued in FL

Practice address

103 Solana Rd Ste B
Ponte Vedra Beach, FL 32082-2231

Phone

(904) 273-2717

Fax

(904) 273-0410

NPI assigned

Jun 1, 2006

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

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783987200000",
    "number": "1598702102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 SOLANA ROAD SUITE B",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "32082",
            "telephone_number": "904-273-2717",
            "fax_number": "904-273-0410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 SOLANA RD STE B",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320822231",
            "telephone_number": "904-273-2717",
            "fax_number": "904-273-0410"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "614 E Twincourt Trl",
            "address_purpose": "LOCATION",
            "city": "Saint Augustine",
            "state": "FL",
            "postal_code": "320959090",
            "country_code": "US",
            "telephone_number": "904-808-7107",
            "fax_number": "904-287-8885",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "791 Amelia Island Pkwy",
            "address_purpose": "LOCATION",
            "city": "Fernandina Beach",
            "state": "FL",
            "postal_code": "320349126",
            "country_code": "US",
            "telephone_number": "904-261-7500",
            "fax_number": "904-261-2166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EARLEY",
        "first_name": "NICOLE",
        "middle_name": "B",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-01",
        "last_updated": "2026-07-14",
        "certification_date": "2026-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9121949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Physician Assistant in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.