MEDICARE: CHRISTINE A. CZEPIZAK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA 2198	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043436165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE A. CZEPIZAK PA-C

Provider Business Mailing Address
First Line	:	14384 MARSH HAMMOCK DR S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-1868
Country	:	US
Telephone Number	:	904-463-2847
Fax Number	:

Provider Business Practice Location Address
First Line	:	14384 MARSH HAMMOCK DR S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-1868
Country	:	US
Telephone Number	:	904-381-9500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	11/23/2010

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