Nicole Pauline Detrick

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9119031 Issued in FL

Practice address

6269 Beach Blvd
Jacksonville, FL 32216-2768

Phone

(904) 727-7955

NPI assigned

May 11, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA, FL2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Florida Physician Specialists LLCGroup PAC ID 4486806213, 37 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Medical Center Beaches Hospital, Jacksonville Beach, FL, CCN 100117
• Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Florida Physician Specialists LLC

  • Radiation Oncology Physician
  • Jacksonville, FL
  • NPI 1588917108
  Medicare reassignment Care Compare group NPD (past)
• Hazleton Professional Services

  dba Lehigh Valley Physician Group-Hazleton

  • Internal Medicine Physician
  • Hazleton, PA
  • NPI 1952464638
  Medicare reassignment NPD
• Lehigh Valley Physician Group

  dba LVPG Developmental Pediatrics

  • Developmental - Behavioral Pediatrics Physician
  • Allentown, PA
  • NPI 1780155689
  Medicare reassignment
• Florida Physician Specialists LLC

  dba Urology Associates of Northeast Florida

  • Urology Physician
  • Orange Park, FL
  • NPI 1932444254
  NPD
• Lehigh Valley Physician Group

  dba LVPG Family and Internal Medicine - East Stroudsburg

  • Family Medicine Physician
  • East Stroudsburg, PA
  • NPI 1245093368
  NPD
• Lehigh Valley Physician Group

  dba LVPG Family and Internal Medicine - Tobyhanna

  • Family Medicine Physician
  • Tobyhanna, PA
  • NPI 1336902469
  NPD
• Pulmonary Associates PC

  • Pulmonary Disease Physician
  • Allentown, PA
  • NPI 1245209022
  NPD (past)

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

• Baptist Medical Center of the Beaches, Inc

  • General Acute Care Hospital
  • Jacksonville Beach, FL
  • NPI 1821155912
  Care Compare affiliation
• Southern Baptist Hospital of Florida Inc

  dba Baptist Medical Center

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1578620449
  Care Compare affiliation

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

{
    "created_epoch": "1683763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734480000000",
    "number": "1760172761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4513 COBBLEFIELD CIR E",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322247995",
            "telephone_number": "908-303-4211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6269 BEACH BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322162768",
            "telephone_number": "904-727-7955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETRICK",
        "first_name": "NICOLE",
        "middle_name": "PAULINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-11",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA064732",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9119031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Davalt Destephano, OT
• Patricia Ann Destephano, OTR
• Roseline A Desvaristes, M.D.
• Kevin John Determan, B.S.,D.C.,F.A.S.A.
• Jonathan L Detlefs, EXEMPT APP.
• Catherine Dettelbach Lake, FNP-C
• William Naragon Deuring, DMD
• Eric Christopher Deussing, MD
• Amie G Deutch, MD
• Zachary Deutch, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; 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.