Nicole Aileen Ortlieb

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1200729 Issued in FL

Practice address

96112 Lanceford LN
Fernandina Beach, FL 32034-6197

Phone

(301) 520-0658

NPI assigned

Dec 4, 2023

Sex

Female

Sole proprietor

Yes

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: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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 Center for Dermatology, P.a.

  • Dermatology Physician
  • St Augustine, FL
  • NPI 1073870341
  Medicare reassignment

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

{
    "created_epoch": "1701648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701648000000",
    "number": "1801663539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96112 LANCEFORD LN",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320346197",
            "telephone_number": "301-520-0658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96112 LANCEFORD LN",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320346197",
            "telephone_number": "301-520-0658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ORTLIEB",
        "first_name": "NICOLE",
        "middle_name": "AILEEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-12-04",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "1200729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Robert Olbina, DDS
• Chason Garrett Oliver, DPT
• Eric M Olson, D.D.S.
• On Top Therapy LLC
• Kathia A. Ortiz-Cantillo, M.D,
• Claude Ken Owens, D.D.S.
• Jessica Packard, MSW
• David P Page, MD
• Bethany G Paige, RMHCI
• Nickolas Paris, PT, DPT

• Physician Assistant in Fernandina Beach, FL
• Providers in Fernandina Beach, 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 4, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.