NICOLE ALLEY HASTABA (PA-C) – Physician Assistant, NPI 1043550775

NICOLE ALLEY HASTABA (PA-C) is a healthcare provider. based in Riviera beach, Florida. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA-C. They hold a License No. PA9107111 (FL). The NPI Number for NICOLE ALLEY HASTABA (PA-C) is 1043550775

Main info

Female
14 Years Of Experience
Accepts Medicare Assignment
Name
NICOLE ALLEY HASTABA (PA-C)
NPI
1043550775
Phone
(812) 202-0124
Address
5380 N OCEAN DR
Enumeration Date
16 February 2013
Last Update Date
26 February 2015

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5617767041
Graduation Year
2012 (14 years ago)
PAC ID
0446485585
Group Practice PAC ID
1052491412
Professional Enrollment ID
I20131028001013
Address ID
FL334104276PA11030DRXX400
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience40
Completeness75
Years active:13State licenses:1Digital endpointsOther names

9,231 PHYSICIAN ASSISTANT in FL

Provider Addresses for NICOLE ALLEY HASTABA (PA-C)

  • 5380 N OCEAN DR

    EASTPOINTE 1- 11G

    RIVIERA BEACH, FL 334042515

    Phone: (812) 202-0124

    Type: Mailing

  • 11030 RCA CENTER DR

    SUITE 3015

    PALM BEACH GARDENS, FL 334104276

    Phone: (561) 776-7041

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 115 Open Payments records for all available years, with a total value of $2,258.

Total Amount is formed as General ($2,258) + Research ($0) + Ownership ($0) = $2,258.

Last reported payment date: 2024-12-19 • Largest payer in this snapshot: ABBVIE INC. ($848).

Total Amount

$2,258

General + Research + Ownership

Payments

115

Total payment records

General Amount

$2,258

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-19

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2013-10-28

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20131028001013IPhysician AssistantFLTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 33404)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1052491412View full group profile
NameSpecialtyState
-FL
Physician AssistantFL
Physician AssistantFL
D E R M A T O L O G YTN
D E R M A T O L O G YFL
D E R M A T O L O G YFL
Nurse PractitionerFL
D E R M A T O L O G YFL
D E R M A T O L O G YFL

Reviews

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Frequently asked questions

Is NICOLE ALLEY HASTABA (PA-C) listed with a National Provider Identifier?
Yes — NICOLE ALLEY HASTABA (PA-C) has NPI 1043550775 on file in the registry.
Is NICOLE ALLEY HASTABA (PA-C) still an active registrant?
NICOLE ALLEY HASTABA (PA-C) carries an active NPI according to the public dataset.
How would a patient describe NICOLE ALLEY HASTABA (PA-C)'s focus?
For NICOLE ALLEY HASTABA (PA-C), the primary taxonomy reads as Physician Assistant. Clinical services aligned with this taxonomy classification.
Where in Florida is NICOLE ALLEY HASTABA (PA-C) registered?
Use Riviera Beach, Florida as the headline location for NICOLE ALLEY HASTABA (PA-C) here.
Does NICOLE ALLEY HASTABA (PA-C) accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

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