Provider Demographics
NPI:1023153418
Name:WELCH, CELESTE NADINE (PA-C)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:NADINE
Last Name:WELCH
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 1:142 CAPRI DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-2232
Mailing Address - Country:US
Mailing Address - Phone:386-405-2145
Mailing Address - Fax:
Practice Address - Street 1:301 MEMORIAL MEDICAL PARKWAY
Practice Address - Street 2:FLORIDA MEMORIAL MEDICAL CENTER
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-231-3023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104887363A00000X
KYPA1000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant