MEDICARE: MRS. ROSE MARIE CELESTIN 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	PA9101370	FL

General Provider Information

NPI Number	:	1134263510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROSE MARIE CELESTIN PA-C

Provider Business Mailing Address
First Line	:	322 CALLIOPE ST
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-4616
Country	:	US
Telephone Number	:	407-909-0253
Fax Number	:

Provider Business Practice Location Address
First Line	:	2551 BOGGY CREEK RD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-3806
Country	:	US
Telephone Number	:	407-348-0990
Fax Number	:

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

Provider Enumeration Date	:	02/18/2007
Last Update Date	:	03/07/2023

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