Talia Marie Nieto
Physician Assistant in Jacksonville, NC. Individual provider (NPI-1).
NPI number1124954375
StatusActive
Last updated in NPPESSep 22, 2026
Details
- NPI
- 1124954375
- Entity type
- Individual (NPI-1)
- Name
- Talia Marie Nieto
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 23, 2026
- Certification date
- Sep 22, 2026
- Last updated
- Sep 22, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | – | – | Yes |
Practice location
114 Memorial DrJacksonville, NC 28546-6328
Phone 910-353-9688
Mailing address
121 Fox BlvdMassapequa, NY 11758-7253
Other practice locations
108 Lakeside Dr
Sneads Ferry, NC 28460-9415
Sneads Ferry, NC 28460-9415
Phone 910-327-5437
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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