Healthcare Provider Details

I. General information

NPI: 1861404899
Provider Name (Legal Business Name): NICOLE ELAINE FIFER PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE ELAINE SCHARRER PA C

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BISHOP ESTATES RD
JACKSONVILLE FL
32259-4244
US

IV. Provider business mailing address

PO BOX 45443
SALT LAKE CITY UT
84145-0443
US

V. Phone/Fax

Practice location:
  • Phone: 904-287-2794
  • Fax: 904-287-5362
Mailing address:
  • Phone: 904-202-1032
  • Fax: 904-376-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA200082
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA200082
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9108411
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: