Provider Demographics
NPI:1124494661
Name:PALOMBA, NICHOLE M (PA-C)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:M
Last Name:PALOMBA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:M
Other - Last Name:ROSATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5070 MINTON RD NW STE 3
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1157
Mailing Address - Country:US
Mailing Address - Phone:321-768-1600
Mailing Address - Fax:321-799-4903
Practice Address - Street 1:5070 MINTON RD NW STE 3
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1157
Practice Address - Country:US
Practice Address - Phone:321-768-1600
Practice Address - Fax:321-799-4903
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2025-10-27
Deactivation Date:2025-10-02
Deactivation Code:
Reactivation Date:2025-10-22
Provider Licenses
StateLicense IDTaxonomies
FLPA120411363A00000X
MAPA5551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant