MEDICARE: NICHOLAS ANTHONY JOERGER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		FL

General Provider Information

NPI Number	:	1538019229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS ANTHONY JOERGER

Provider Business Mailing Address
First Line	:	148 LEADLINE LN
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-8480
Country	:	US
Telephone Number	:	610-999-7724
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 N HIMES AVE STE 175
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-7095
Country	:	US
Telephone Number	:	610-999-7724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “ NICHOLAS ANTHONY JOERGER ” Practice Location

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