Provider Demographics
NPI:1982309795
Name:CIECHANOWSKI, PETER CASIMIR (APRN)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:CASIMIR
Last Name:CIECHANOWSKI
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13850 83RD ST
Mailing Address - Street 2:
Mailing Address - City:FELLSMERE
Mailing Address - State:FL
Mailing Address - Zip Code:32948-6267
Mailing Address - Country:US
Mailing Address - Phone:412-758-1035
Mailing Address - Fax:
Practice Address - Street 1:1900 S HARBOR CITY BLVD STE 225
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4789
Practice Address - Country:US
Practice Address - Phone:321-216-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11025562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily