Provider Demographics
NPI:1407173917
Name:JECEN, MICHAEL STANLEY (PA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STANLEY
Last Name:JECEN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:303 NORTH CLYDE MORRIS BLVD.
Mailing Address - Street 2:HALIFAX HEALTH MEDICAL CENTER
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2709
Mailing Address - Country:US
Mailing Address - Phone:386-425-2285
Mailing Address - Fax:386-425-7522
Practice Address - Street 1:303 NORTH CLYDE MORRIS BLVD.
Practice Address - Street 2:HALIFAX HEALTH MEDICAL CENTER
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2709
Practice Address - Country:US
Practice Address - Phone:386-425-2285
Practice Address - Fax:386-425-7522
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2011-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105437363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical