Individual provider Active NPI

Candice D Martens Nicoll, ARNP

  • Family Nurse Practitioner
  • North Port, FL
National Provider Identifier
1669798641
Registry record updated Sep 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP3382212 Issued in FL
Practice address
2975 Bobcat Village Center Rd
Ste. 100
North Port, FL 34288-4600
Phone
(941) 423-9936
Fax
(941) 426-9794
NPI assigned
Apr 15, 2010
Last updated
Sep 28, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ARNP3382212 FL Primary

Addresses

Primary practice location

2975 Bobcat Village Center Rd
Ste. 100
North Port, FL 34288-4600

Mailing address

3434 Hancock Bridge Pkwy
N Ft Myers, FL 33903-7094
Phone (877) 856-3774

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20110920000288 FL Practitioner - Nurse Practitioner 3274704465 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2975 Bobcat Village Ctr Rd
Suite 100
North Port, FL 34288-4603
Phone (941) 423-9936

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Prime Health of North Port LLC CurrentSince Dec 1, 2015 Accepting new patients

Locations

2975 Bobcat Village Center Rd
Unit 100
North Port, FL 34288
Phone (941) 423-9936

Organizations & group practices 1

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.

Hospital & facility affiliations 2

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": "1271289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475020800000",
    "number": "1669798641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3434 HANCOCK BRIDGE PKWY",
            "city": "N FT MYERS",
            "state": "FL",
            "postal_code": "339037094",
            "telephone_number": "877-856-3774",
            "fax_number": "239-599-2625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 BOBCAT VILLAGE CENTER RD",
            "address_2": "STE. 100",
            "city": "NORTH PORT",
            "state": "FL",
            "postal_code": "342884600",
            "telephone_number": "941-423-9936",
            "fax_number": "941-426-9794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTENS NICOLL",
        "first_name": "CANDICE",
        "middle_name": "D",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-15",
        "last_updated": "2016-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP3382212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Port, FL

Sources for this page

Verify at the official NPI Registry.