Nicolle De Siqueira, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9117049 Issued in FL

Practice address

11645 Biscayne Blvd Ste 100
North Miami, FL 33181-3155

Phone

(305) 538-8835

Fax

(305) 994-0054

NPI assigned

Jan 27, 2023

Last updated

Aug 5, 2025By the provider in NPPES

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 identifiers 1

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

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Miami Beach Community Health Center, Inc.Group PAC ID 8123090925, 49 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Miami Beach Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Miami Beach, FL
  • NPI 1063411874
  Medicare reassignment Care Compare group
• Miami Beach Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Miami, FL
  • NPI 1053780734
  NPD
• Miami Beach Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Miami, FL
  • NPI 1104357565
  NPD
• Miami Beach Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Miami, FL
  • NPI 1821667981
  NPD (past)

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

{
    "created_epoch": "1674777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1942916440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11645 BISCAYNE BLVD STE 207",
            "city": "NORTH MIAMI",
            "state": "FL",
            "postal_code": "331813138",
            "telephone_number": "305-538-8835",
            "fax_number": "305-994-0054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11645 BISCAYNE BLVD STE 100",
            "city": "NORTH MIAMI",
            "state": "FL",
            "postal_code": "331813155",
            "telephone_number": "305-538-8835",
            "fax_number": "305-994-0054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE SIQUEIRA",
        "first_name": "NICOLLE",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-27",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9117049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117047800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Latasha R Delaney

• Medical Physician Assistant in North Miami, FL
• Providers in North Miami, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2025; 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.