Provider Demographics
NPI:1659510261
Name:CECIL, PATRICIA MARLENA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MARLENA
Last Name:CECIL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33970-0220
Mailing Address - Country:US
Mailing Address - Phone:239-369-4088
Mailing Address - Fax:239-369-0588
Practice Address - Street 1:260 BETH STACEY BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6074
Practice Address - Country:US
Practice Address - Phone:239-369-4088
Practice Address - Fax:239-369-0588
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104285363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCQ690YOtherMEDICARE PTAN
FLPA9104285OtherPA LICENSE