Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Nicole Russo Cavignaro, PA-C

Individual provider Physician Assistant · NPI 1508527748

Nicole Russo Cavignaro, PA-C is a Physician Assistant in St Augustine, Florida. Qualified in 2022, 4 years ago. Practices with Bold City Dermatology LLC, a 4-clinician group and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
4
Licensed in
FL
In the registry since
2022
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

316 Paseo Reyes Dr
St Augustine, FL 32095-8464
Phone: (904) 544-5800
Fax: (904) 544-5800
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA9117532 (FL)

Record details

NPI number1508527748
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJanuary 9, 2022
Last updated in NPPESAugust 12, 2024
Certification dateAugust 12, 2024

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Bold City Dermatology Llc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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