Individual provider Active NPI

Nicole Moskal, PA-C

  • Physician Assistant
  • Winter Park, FL
National Provider Identifier
1972844660
Registry record updated Sep 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9108054 Issued in FL
Practice address
1925 Mizell Ave Ste 105
Winter Park, FL 32792-4155
Phone
(407) 646-7410
Fax
(407) 646-7412
NPI assigned
Mar 6, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 003708 OH
Surgical Physician Assistant 363AS0400X PA9108054 FL
Physician Assistant 363A00000X PA9108054 FL Primary

Addresses

Primary practice location

1925 Mizell Ave Ste 105
Winter Park, FL 32792-4155

Mailing address

1925 Mizell Ave Ste 105
Winter Park, FL 32792-4155
Phone (407) 646-7410

Other identifiers 1

IdentifierTypeStateIssuer
1109921OtherFLNCCPA CERT

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150223001736 FL Practitioner - Physician Assistant 7719126143 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Hospital Medical Group IncGroup PAC ID 0749186153, 1,735 clinicians

Practice addresses (Care Compare)

2600 Westhall LN
Maitland, FL 32751-7102
Phone (407) 200-2700

601 E Rollins St
Orlando, FL 32803-1248
Phone (407) 303-2570

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
003708OHMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Physician Assistant CurrentSince Sep 12, 2022 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Sep 12, 2022 Accepting new patients
Southeastern Clinical Services,Inc. Surgical PastSince Jun 5, 2012 Accepting new patients

Locations

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

1925 Mizell Ave
Ste 105
Winter Park, FL 32792
Phone (407) 646-7410

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: nmoskal130817@adventhealth.direct-ci.com

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1362528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1972844660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 MIZELL AVE STE 105",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327924155",
            "telephone_number": "407-646-7410",
            "fax_number": "407-646-7412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 MIZELL AVE STE 105",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327924155",
            "telephone_number": "407-646-7410",
            "fax_number": "407-646-7412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSKAL",
        "first_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-06",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OH",
            "license": "003708",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9108054",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9108054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA CERT",
            "identifier": "1109921",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Park, FL

Sources for this page

Verify at the official NPI Registry.