MRS. MADELYN MCNAMARA NICKERSON (NPI# 1609327816) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609327816 |
| Entity Type | Individual |
| Full Name | MRS. MADELYN MCNAMARA NICKERSON |
| Other Name | MS. MADELYN MCNAMARA SCRENOCK |
| Credential | PA-C |
| Practice Address |
6801 4th St N St Petersburg FL 33702-6844 |
| Mailing Address |
2995 Drew St Fl 2 Clearwater FL 33759-3012 |
| Practice Telephone | 7278223238 |
| Practice Fax Number | 7278231278 |
| Mailing Telephone | 7275321355 |
| Mailing Fax Number | 8136352613 |
| Enumeration Date | 2016-10-23 |
| Last Update Date | 2020-11-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA9109804 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 019646400 | 05 |
| Street Address |
6801 4TH ST N |
| City | ST PETERSBURG |
| State | FL |
| Zip Code | 33702-6844 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700205069 | Carol Thuy Vy Tran | Family Medicine | 6801 4th St N, St Petersburg, FL 33702 | 2014-04-15 |
| 1336672096 | Don Edward Parish | Internal Medicine | 6801 4th St N, St Petersburg, FL 33702-6844 | 2017-04-09 |
| 1609281245 | Bettina Dennise Schutzbach | Family Medicine | 6801 4th St N, St Petersburg, FL 33702-6844 | 2014-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700419637 | Lea Diana Stemplewski | Occupational Therapist | 8950 Dr. Mlk Jr. St. North, Ste 190, St. Petersburg, FL 33702 | 2020-02-19 |
| 1366919557 | Svetlana Nagle | Nurse Practitioner | 10601 Gandy Blvd. N., 5305, St Petersburg, FL 33702 | 2018-10-25 |
| 1457835613 | Joseph Kirchmer | Physical Therapy Assistant | 7101 9th St N, St Petersburg, FL 33702 | 2018-09-23 |
| 1386135176 | Valencia Gibson | Behavior Technician | 8950 Doctor Martin Luther King Jr Street North, 190, Saint Petersburg, FL 33702 | 2018-05-29 |
| 1740778760 | Nicole S Kapr | Behavior Technician | 8950 Doctor Mlk Street North, 190, St. Petersburg, FL 33702 | 2018-04-25 |
| 1003316050 | Sonya Lesnefsky | Behavior Technician | 8950 Dr Mlk St N #190, Saint Petersburg, FL 33702 | 2018-02-16 |
| 1003315086 | Erin Nicole Rogers | Behavior Technician | 8950 Dr Mlk Jr St N, #190, St Petersburg, FL 33702 | 2018-02-06 |
| 1881192482 | Carrie Langbo | Genetic Counselor, MS | Informeddna, 877 Executive Center Drive W, Suite 206, St. Petersburg, FL 33702 | 2018-01-29 |
| 1891203485 | Healthy Lifestyles Tampa Bay LLC | Psychologist | 8479 Dr Martin Luther King Jr St N, St Petersburg, FL 33702 | 2018-01-17 |
| 1649787235 | Gurdeep Singh | Behavior Technician | 8950 Dr Mlk Street N, Suite 190, Saint Petersburg, FL 33702 | 2018-01-04 |
| Find all providers in zip 33702 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558969378 | Odalys Caro | Physician Assistant | 6500 20th St N, St Petersburg, FL 33702-7112 | 2020-10-14 |
| 1417587106 | Hannah Newman | Physician Assistant | 1667 Brightwaters Blvd Ne, St Petersburg, FL 33704-3813 | 2020-01-22 |
| 1740752526 | Michelle Ciesla | Physician Assistant | 2640 14th Ave N, St Petersburg, FL 33713-5813 | 2018-12-18 |
| 1205328978 | Alfredo Jose Gotera Avila | Physician Assistant | 871 Ibis Walk Pl N Unit 3204, St Petersburg, FL 33716-3857 | 2018-05-30 |
| 1578074043 | Ekta H Patel | Physician Assistant | 125 5th Ave Ne Apt 260, St Petersburg, FL 33701-3038 | 2017-10-23 |
| 1225495526 | Kelly Marie Egan | Physician Assistant | 2736 4th Ave N, St Petersburg, FL 33713-7824 | 2016-01-19 |
| 1992125264 | Casie J Parker | Physician Assistant | 603 7th Street S, Ste 540, St Petersburg, FL 33701 | 2014-04-24 |
| 1407174824 | Gina Mendez | Physician Assistant | 7901 4th St N Ste 300, St Petersburg, FL 33702-4399 | 2010-05-10 |
| 1588990063 | Garrett A Babbs | Physician Assistant | 1344 22nd St South, St Petersburg, FL 33712 | 2009-10-19 |
| 1720211725 | Christina Marie Tomasino | Physician Assistant | 3140 9th Ave N, St Petersburg, FL 33713-6626 | 2009-08-25 |
| Find all providers in ST PETERSBURG | ||||
| City | ST PETERSBURG |
| Zip Code | 33702 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.