Healthcare Provider Details

I. General information

NPI: 1982309795
Provider Name (Legal Business Name): PETER CASIMIR CIECHANOWSKI APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 04/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S HARBOR CITY BLVD STE 225
MELBOURNE FL
32901-4789
US

IV. Provider business mailing address

13850 83RD ST
FELLSMERE FL
32948-6267
US

V. Phone/Fax

Practice location:
  • Phone: 321-216-2288
  • Fax:
Mailing address:
  • Phone: 412-758-1035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11025562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: