Nicole Rothe, PA-C, MS CCC-SLP

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9122119 Issued in FL

Practice address

2 Shircliff Way Ste 200
Jacksonville, FL 32204-4766

Phone

(904) 308-2006

NPI assigned

May 21, 2019

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

Other names 1

• Nicole Nelsen Former name

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

Master of Science

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

{
    "created_epoch": "1558396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785801600000",
    "number": "1740847128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 SHIRCLIFF WAY STE 200",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044766",
            "telephone_number": "904-308-2006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 SHIRCLIFF WAY STE 200",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044766",
            "telephone_number": "904-308-2006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTHE",
        "first_name": "NICOLE",
        "credential": "PA-C, MS CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-21",
        "last_updated": "2026-08-04",
        "certification_date": "2026-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9122119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "NELSEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Julia Roth, PT, DPT, OCS
• Nathan Thomas Roth, M.D.
• Rayna Roth
• Tricia L Roth
• Marc Anthony Rothe Jr., DPT
• Jennifer Dawn Rothenberg, PHARMD
• Martyn Gregory Rothermel
• Jennifer G Rothrock, CLC
• Jerome Philip Rothstein, D.D.S.
• Mitchell S Rothstein, MD

• Surgical Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 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.