Provider Demographics
NPI:1801864954
Name:CETIN, KENAN MURAT (PA-C MBA)
Entity Type:Individual
Prefix:
First Name:KENAN
Middle Name:MURAT
Last Name:CETIN
Suffix:
Gender:M
Credentials:PA-C MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-8716
Mailing Address - Country:US
Mailing Address - Phone:863-491-2277
Mailing Address - Fax:863-491-3077
Practice Address - Street 1:819 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-8716
Practice Address - Country:US
Practice Address - Phone:863-491-2277
Practice Address - Fax:863-491-3077
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA002634363AM0700X
FLPA2634363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290004100Medicaid
FL290004100Medicaid
FLE2096ZMedicare ID - Type UnspecifiedMEDICARE