NICHOLAS BRENNAN WAGNER MD
NPI 1003583642
Student in an Organized Health Care Education/Training Program in Tampa, FL

Q: What is Nicholas Wagner's NPI number?

The NPI number for Nicholas Wagner is 1003583642. It was assigned to this individual provider in the NPPES registry on August 23, 2021.

Q: What is Nicholas Wagner's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Nicholas Wagner was last updated on May 3, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 23, 2021PECOS Enrolled

17 DAVIS BLVD STE 308, TAMPA, FL 33606(813) 974-2201 Get Directions Write a Review

NPPES record last updated: May 3, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 3, 2022, Aug 23, 2021 (2 updates tracked since 2021).

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About Nicholas Brennan Wagner Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICHOLAS BRENNAN WAGNER MD (NPI 1003583642) is an individual student in an organized health care education/training program in Tampa, Florida and active in the NPI registry since August 2021. He is enrolled in Medicare PECOS, maintains a secondary practice location in Macon, and is a graduate of Mercer University School Of Medicine (2022).

NPPES Registry Identity

NPI1003583642

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameNICHOLAS BRENNAN WAGNERCredential: MD

Location Address17 DAVIS BLVD STE 308Tampa, FL 33606-3438

Mailing Address17 Davis Blvd Ste 308Tampa, FL 33606-3438 · (813) 974-2201

Phone(813) 974-2201

Sole ProprietorNo

Medical School CMSMercer University School Of MedicineGraduated 2022

Enumeration DateAugust 23, 2021

Last NPPES UpdateMay 3, 20222 updates tracked since enumeration

NPPES CertifiedMay 3, 2022

✔ NPI 1003583642 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

17 DAVIS BLVD STE 308, Tampa, FL 33606

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Secondary Practice Location 1

Location 11550 College StMacon, GA 31207-1500 · Phone (478) 301-2600

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Oscar Health Maintenance Organization of Florida, Oscar Insurance Company.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nicholas Brennan Wagner Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4981184934

PECOS Enrollment IDI20260218000272

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARISOL GOMEZ MD

Student in an Organized Health Care Education/Training Program