MRS. NICHOLE WALLACE (PA) – Medical Physician Assistant, NPI 1114379708
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
9,231 PHYSICIAN ASSISTANT in FL
Provider Addresses for MRS. NICHOLE WALLACE (PA)
10959 W Colonial Dr
Units 6&8
Ocoee, FL 34761
Phone: (407) 554-4591
Type: Location
833, Penfield Street, The Bronx, Bronx County, New York, 10470, United States
BRONX, NY 104701322
Phone: (718) 708-1913
Type: Mailing
NYC Health + Hospitals/Woodhull, 760, Broadway, Brooklyn, Kings County, New York, 11206, United States
BROOKLYN, NY 112065317
Phone: (718) 312-2312
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 27 Open Payments records for all available years, with a total value of $517.
Total Amount is formed as General ($517) + Research ($0) + Ownership ($0) = $517.
Last reported payment date: 2024-09-17 • Largest payer in this snapshot: ABBVIE INC. ($282).
Total Amount
$517
General + Research + Ownership
Payments
27
Total payment records
General Amount
$517
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-17
Latest reported date
Top Companies
Largest payers in this snapshot
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: 2024-04-15
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20210510001719 | I | Physician Assistant | NY | TBD |
| I20240415001291 | I | Physician Assistant | FL | TBD |
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.
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 34761)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | FL | |
| - | FL | |
| Physician Assistant | FL | |
| Nurse Practitioner | FL | |
| - | FL | |
| - | FL | |
| Physician Assistant | FL | |
| Physician Assistant | FL | |
| - | FL | |
| - | FL |
Reviews
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