| Nicole Aileen Ortlieb, | |
|
96112 Lanceford Ln, Fernandina Beach, FL 32034-6197 | |
| (301) 520-0658 | |
| Not Available |
| Full Name | Nicole Aileen Ortlieb |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant |
| Location | 96112 Lanceford Ln, Fernandina Beach, Florida |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801663539 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 1200729 (Florida) | Primary |
| Entity Name | Florida Center for Dermatology PA |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1073870341 PECOS PAC ID: 0244486017 Enrollment ID: O20120809000748 |
| Mailing Address | Practice Location Address |
|---|---|
| Nicole Aileen Ortlieb, 96112 Lanceford Ln, Fernandina Beach, FL 32034-6197 Ph: (301) 520-0658 | Nicole Aileen Ortlieb, 96112 Lanceford Ln, Fernandina Beach, FL 32034-6197 Ph: (301) 520-0658 |
Caroline Gray Mckee, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1348 S 18th St Ste 200, Fernandina Beach, FL 32034 Phone: 904-202-6683 Fax: 904-376-3062 |
Courtney Marshall, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1132 S 14th St, Fernandina Beach, FL 32034 Phone: 904-432-3061 Fax: 904-432-3062 |
Scott Allen Weeks, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1348 S 18th St Ste 200, Fernandina Beach, FL 32034 Phone: 042-619-7869 Fax: 904-277-4143 |
Mr. Robert Lee Gray Ii, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1987 S 8th St, Fernandina Beach, FL 32034 Phone: 904-624-7003 |
Amy Brooke Mendonsa, PA Physician Assistant Medicare: Medicare Enrolled Practice Location: 96279 Brady Point Rd, Fernandina Beach, FL 32034 Phone: 904-321-0088 Fax: 904-321-0016 |
Molly Grassman, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1699 S 14th St Ste 16, Fernandina Beach, FL 32034 Phone: 904-223-3321 Fax: 904-223-2169 |
Randall B Fulford, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 96279 Brady Point Rd, Fernandina Beach, FL 32034 Phone: 904-321-0088 |