Provider Demographics
NPI:1609901792
Name:GARCIA, NICOLE A (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:A
Other - Last Name:ABUKHALAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13241 BARTRAM PARK BLVD UNIT 2601
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5219
Mailing Address - Country:US
Mailing Address - Phone:904-298-1800
Mailing Address - Fax:904-298-1802
Practice Address - Street 1:13241 BARTRAM PARK BLVD UNIT 2601
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5219
Practice Address - Country:US
Practice Address - Phone:904-298-1800
Practice Address - Fax:904-298-1802
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104053363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD387TOtherFL MEDICARE
FL292750100Medicaid