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

Nicole Otero, PA

Individual provider Athletic Trainer · NPI 1104204320

Nicole Otero, PA is a Physician Assistant in Gilbert, Arizona. Qualified in 2021, 5 years ago. Practices with Banner Physician Specialists Arizona LLC, a 372-clinician group and accepts Medicare assignment.

Years since qualifying
5
In the registry since
2015
Specialties on file
3
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

1900 N Higley Rd
Gilbert, AZ 85234-1604
Phone: (480) 543-2000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X
Athletic Trainer Taxonomy 2255A2300X
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1104204320
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedMay 7, 2015
Last updated in NPPESSeptember 14, 2021
Certification dateSeptember 14, 2021

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Banner Physician Specialists Arizona Llc — 372 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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