Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mrs. Nichole Wallace, PA

Individual provider Medical Physician Assistant · NPI 1114379708

Mrs. Nichole Wallace, PA is a Physician Assistant in Brooklyn, New York. Qualified in 2023, 3 years ago. Practices with Carespot of Orlando Hsi Urgent Care LLC, a 57-clinician group, works from 2 locations and accepts Medicare assignment.

Years since qualifying
3
In the registry since
2016
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

760 Broadway
Brooklyn, NY 11206-5317
Phone: (718) 312-2312
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 10959 W Colonial Dr, Ocoee, FL 34761 — (407) 554-4591

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X

Record details

NPI number1114379708
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedJuly 6, 2016
Last updated in NPPESAugust 18, 2023
Certification dateAugust 18, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Carespot Of Orlando Hsi Urgent Care Llc — 57 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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