Nicole Ann Jaffe, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY12063 Issued in FL

Practice address

12499 Brantley Commons CT Ste 101
Fort Myers, FL 33907-5694

Phone

(239) 278-3443

NPI assigned

Oct 11, 2023

Last updated

Oct 11, 2023By the provider in NPPES

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: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Center for Psychology, PAGroup PAC ID 0840287991, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Center for Psychology, PA

  • Clinical Neuropsychologist
  • Fort Myers, FL
  • NPI 1952309296
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1696982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1649051194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12499 BRANTLEY COMMONS CT STE 101",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339075694",
            "telephone_number": "239-278-3443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12499 BRANTLEY COMMONS CT STE 101",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339075694",
            "telephone_number": "239-278-3443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAFFE",
        "first_name": "NICOLE",
        "middle_name": "ANN",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-11",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY12063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tomas Jacome, MD
• Jahan Jadauji, M.D.
• Jade Clinic Family and Wellness Center Corp
• Jaesen Petretta Inc
• Christine M Jaffe, CPNP, MS, RN
• Jeanne Ann Jagodzinski, PMHNP-BC
• Ahmed I Jakda, MD
• Julie Ann Jakobi, RMHCI
• Lindsay L Jakovac, APRN, FNP-BC
• David Jalanivich, CCP

• Clinical Psychologist in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Clinical Psychologist in Florida

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