Healthcare Provider Details

I. General information

NPI: 1285455881
Provider Name (Legal Business Name): CARLY M CEPELAK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 08/21/2025
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SOUTH FORT HARRISON AVENUE SUITE 101
CLEARWATER FL
33756
US

IV. Provider business mailing address

1001 SOUTH FORT HARRISON AVENUE SUITE 101
CLEARWATER FL
33756
US

V. Phone/Fax

Practice location:
  • Phone: 727-441-5044
  • Fax: 727-441-5008
Mailing address:
  • Phone: 727-441-5044
  • Fax: 727-441-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: