Healthcare Provider Details

I. General information

NPI: 1073488300
Provider Name (Legal Business Name): FELIPPE FIDELIS LACET PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CELEBRATION PL STE A150
CELEBRATION FL
34747-4970
US

IV. Provider business mailing address

400 CELEBRATION PL STE A150
CELEBRATION FL
34747-4970
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-3824
  • Fax:
Mailing address:
  • Phone: 407-303-3824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9121419
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: