MEDICARE: NICHOLAS T WOLTJEN PA-C

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	363AM0700X	Medical Physician Assistant	MA056346	PA
2	363AM0700X	Medical Physician Assistant	PA9110372	FL

General Provider Information

NPI Number	:	1861827966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS T WOLTJEN PA-C

Provider Business Mailing Address
First Line	:	5070 A1A STE A
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32963-1229
Country	:	US
Telephone Number	:	772-234-3700
Fax Number	:	772-234-3770

Provider Business Practice Location Address
First Line	:	5070 A1A STE A
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32963-1229
Country	:	US
Telephone Number	:	772-234-3700
Fax Number	:	772-234-3770

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

Provider Enumeration Date	:	09/08/2013
Last Update Date	:	05/05/2026

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