Provider Demographics
NPI:1407173917
Name:JECEN, MICHAEL STANLEY (PA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STANLEY
Last Name:JECEN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 740861
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0861
Mailing Address - Country:US
Mailing Address - Phone:904-819-4539
Mailing Address - Fax:904-819-4906
Practice Address - Street 1:110 HEALTH PARK BLVD
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5776
Practice Address - Country:US
Practice Address - Phone:904-823-3401
Practice Address - Fax:904-829-8649
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2024-09-24
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105437363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical