Nicole Edie, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

31120 Issued in FL

Practice address

13000 Sawgrass Village Cir Ste 14
Ponte Vedra, FL 32082-3078

Phone

(904) 881-7612

NPI assigned

Jul 11, 2022

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Jba South LLC

  • Physical Therapist
  • Ponte Vedra Beach, FL
  • NPI 1144938481
  NPD

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

{
    "created_epoch": "1657497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657497600000",
    "number": "1841924404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13000 SAWGRASS VILLAGE CIR STE 14",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320823078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13000 SAWGRASS VILLAGE CIR STE 14",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320823078",
            "telephone_number": "904-881-7612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDIE",
        "first_name": "NICOLE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-11",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "31120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald a. Barnhorst Jr. MD PA
• Megan Grace Douberly, PT, DPT
• Dr. Beth Gabriel Psychiatry LLC
• Emma Corrine Drach, DO
• Amber Lachelle Dunn
• Elizabeth Milano, LCSW PLLC
• Leah Darla Elkhoury, DMD
• Endodontics 2 PLLC
• Zachary Engel, DPT
• David Engelman, MA

• Physical Therapy Assistant in Ponte Vedra, FL
• Providers in Ponte Vedra, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.