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General NPI Number Information
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NPI Number | 1588138663
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Entity Type | Individual
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Provider Name | NICHOLLE C ROTHENGASS PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 2254 HIGHWAY A1A
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-4922
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Country | US
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Telephone | 813-786-2691
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Fax | 321-779-7425
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Provider Business Mailing Address
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Address Line | 1029 PARK DR APT 27
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-3638
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Country | US
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Telephone | 813-786-2691
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9111908
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License Number State | FL
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