Provider Demographics
NPI:1285455881
Name:CEPELAK, CARLY M
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:M
Last Name:CEPELAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1490
Mailing Address - Country:US
Mailing Address - Phone:813-253-3333
Mailing Address - Fax:
Practice Address - Street 1:3421 W EMPEDRADO ST APT B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7063
Practice Address - Country:US
Practice Address - Phone:813-541-1308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant