Provider Demographics
NPI:1841209749
Name:CEJKOVA, MARIJANA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIJANA
Middle Name:
Last Name:CEJKOVA
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 1:1805 CYPRESS BROOK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4417
Mailing Address - Country:US
Mailing Address - Phone:727-264-8833
Mailing Address - Fax:
Practice Address - Street 1:1805 CYPRESS BROOK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4417
Practice Address - Country:US
Practice Address - Phone:727-264-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103573363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDS2914OtherPROV AND GROUP #
FL002WHOtherBLUE CROSS/BLUE SHIELD FLORIDA GROUP ID#
FLP01014387OtherRAILROAD MEDICARE
FLY0A4SOtherBLUE CROSS/BLUE SHIELD FLORIDA ID#
FLAB132YMedicare PIN
FLDS2914OtherPROV AND GROUP #
FLP01014387OtherRAILROAD MEDICARE