Healthcare Provider Details

I. General information

NPI: 1518502483
Provider Name (Legal Business Name): REGAN ELIZABETH CICEKLIC PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2923 S FEDERAL HWY STE 100
BOYNTON BEACH FL
33435-7751
US

IV. Provider business mailing address

2923 S FEDERAL HWY STE 100
BOYNTON BEACH FL
33435-7751
US

V. Phone/Fax

Practice location:
  • Phone: 561-752-0100
  • Fax:
Mailing address:
  • Phone: 561-752-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9115908
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: